Document Detail

Primary aldosteronism: are we missing the wood for the trees?
MedLine Citation:
PMID:  22281545     Owner:  NLM     Status:  MEDLINE    
The prevalence of primary aldosteronism (PA) is around 10% of hypertensives, with markedly increased risk of cardiovascular damage compared with age-, sex- and BP-matched essential hypertension (EH). Currently, if hypertension is present in 20% of the population, PA will account for 2%; of these PA patients only 1% are ever screened, let alone diagnosed and treated, and the remaining 99% suboptimally treated, if at all. Mineralocorticoid receptor (MR) antagonists are effective in lowering BP, uniquely vasoprotective and safe when titrated to effect in EH. In resistant hypertension (BP elevated despite 3 or more conventional agents, including a diuretic), which constitutes 20-30% of EH, addition of a low dose MR antagonist reproducibly produces BP lowering of 20-30 mm Hg. Two thirds of PA is unilateral, and normally treated by MR antagonists; in unilateral PA surgery is recommended, but there are also studies reporting MR antagonist therapy to be noninferior over the longer term. There thus seems to be a very strong case for including a low dose MR antagonist in first-line therapy for new hypertension, given its utility and safety across EH, its particular efficacy in resistant hypertension, and its specific benefits for the 99% of subjects with occult PA. We do not have the resources to diagnose PA, but we do have the wherewithal to treat it.
J W Funder
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Publication Detail:
Type:  Journal Article     Date:  2012-01-26
Journal Detail:
Title:  Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et métabolisme     Volume:  44     ISSN:  1439-4286     ISO Abbreviation:  Horm. Metab. Res.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-07     Completed Date:  2012-07-12     Revised Date:  2013-01-07    
Medline Journal Info:
Nlm Unique ID:  0177722     Medline TA:  Horm Metab Res     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  251-3     Citation Subset:  IM    
Copyright Information:
© Georg Thieme Verlag KG Stuttgart · New York.
Prince Henry's Institute, Clayton, Victoria, Australia.
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MeSH Terms
Aldosterone / metabolism
Hyperaldosteronism / diagnosis*,  drug therapy,  metabolism,  physiopathology
Hypertension / diagnosis*,  drug therapy,  metabolism,  physiopathology
Mineralocorticoid Receptor Antagonists
Practice Guidelines as Topic
Reg. No./Substance:
0/Mineralocorticoid Receptor Antagonists; 52-39-1/Aldosterone
Comment In:
Horm Metab Res. 2012 Nov;44(12):927-8; author reply 929-30   [PMID:  22791599 ]

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