The Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension
Authors: Kosuke Inoue, Tetsuo Nishikawa
Journal: Annals of Internal Medicine (2018)

Letters15 May 2018The Spectrum of Subclinical Primary Aldosteronism and Incident HypertensionKosuke Inoue, MD and Tetsuo Nishikawa, MD, PhDKosuke Inoue, MDUCLA Fielding School of Public Health, Los Angeles, California (K.I.)Search for more papers by this author and Tetsuo Nishikawa, MD, PhDYokohama Rosai Hospital, Yokohama, Japan (T.N.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0024 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their national, community-based cohort study, Brown and colleagues (1) showed that patients with renin suppression and higher aldosterone levels had an increased risk for hypertension through increased mineralocorticoid receptor activation. We agree with the importance of identifying renin-independent aldosteronism, even in normotensive patients. However, we need to be careful about the definition of “subclinical” PA, which is still not established.We believe that the authors' proposed spectrum of the severity of renin-independent aldosteronism should define subclinical PA for normotensive PA (1). In other words, confirmatory tests for PA (oral sodium loading, saline infusion, fludrocortisone suppression, or ...References1. Brown JM, Robinson-Cohen C, Luque-Fernandez MA, Allison MA, Baudrand R, Ix JH, et al. The spectrum of subclinical primary aldosteronism and incident hypertension: a cohort study. Ann Intern Med. 2017;167:630-41. [PMID: 29052707]. doi:10.7326/M17-0882 LinkGoogle Scholar2. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:1889-916. [PMID: 26934393] doi:10.1210/jc.2015-4061 CrossrefMedlineGoogle Scholar3. Funder JW. The potential of ACTH in the genesis of primary aldosteronism. Front Endocrinol (Lausanne). 2016;7:40. [PMID: 27242664] doi:10.3389/fendo.2016.00040 CrossrefMedlineGoogle Scholar4. Inoue K, Omura M, Sugisawa C, Tsurutani Y, Saito J, Nishikawa T. Clinical utility of the adrenocorticotropin stimulation test with/without dexamethasone suppression for definitive and subtype diagnosis of primary aldosteronism. Int J Mol Sci. 2017;18. [PMID: 28468286] doi:10.3390/ijms18050948 CrossrefMedlineGoogle Scholar5. Jiang Y, Zhang C, Wang W, Su T, Zhou W, Jiang L, et al. Diagnostic value of ACTH stimulation test in determining the subtypes of primary aldosteronism. J Clin Endocrinol Metab. 2015;100:1837-44. [PMID: 25695882] doi:10.1210/jc.2014-3551 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: UCLA Fielding School of Public Health, Los Angeles, California (K.I.)Yokohama Rosai Hospital, Yokohama, Japan (T.N.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0024. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension Jenifer M. Brown , Cassianne Robinson-Cohen , Miguel Angel Luque-Fernandez , Matthew A. Allison , Rene Baudrand , Joachim H. Ix , Bryan Kestenbaum , Ian H. de Boer , and Anand Vaidya The Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension J. David Spence The Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension Eugenia Gkaliagkousi , Panagiota Anyfanti , Antonios Lazaridis , and Stella Douma The Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension Jenifer M. Brown and Anand Vaidya Metrics 15 May 2018Volume 168, Issue 10Page: 754-755KeywordsAdrenocorticotropic hormoneAldosteroneFludrocortisoneHypertensionMineralocorticoidsPhenotypesPlasma renin activityPotassiumSodiumYoung adults ePublished: 15 May 2018 Issue Published: 15 May 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...