| Primary Aldosteronism: Are We Missing the Wood for the Trees? | |
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MedLine Citation:
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PMID: 22281545 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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J W Funder |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-1-26 |
Journal Detail:
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Title: Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme Volume: - ISSN: 1439-4286 ISO Abbreviation: - Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-1-27 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0177722 Medline TA: Horm Metab Res Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© Georg Thieme Verlag KG Stuttgart · New York. |
Affiliation:
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Prince Henry's Institute, Clayton, Victoria, Australia. |
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