The Unrecognized Prevalence of Primary Aldosteronism
Authors: Anand Vaidya, Jenifer M. Brown, Robert M. Carey, Mohammed Siddiqui, Gordon H. Williams
Journal: Annals of Internal Medicine (2020)

Letters20 October 2020The Unrecognized Prevalence of Primary AldosteronismAnand Vaidya, MD, MMSc, Jenifer M. Brown, MD, Robert M. Carey, MD, Mohammed Siddiqui, MD, and Gordon H. Williams, MDAnand Vaidya, MD, MMScBrigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (A.V., J.M.B., G.H.W.), Jenifer M. Brown, MDBrigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (A.V., J.M.B., G.H.W.), Robert M. Carey, MDUniversity of Virginia Health System, Charlottesville, Virginia (R.M.C.), Mohammed Siddiqui, MDUniversity of Alabama at Birmingham, Birmingham, Alabama (M.S.), and Gordon H. Williams, MDBrigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (A.V., J.M.B., G.H.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1097 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Piaditis and colleagues describe their previous work in which they discovered a high prevalence of primary aldosteronism in cohorts with hypertension but also among those with normal blood pressure who had a higher risk for incident hypertension. Indeed, we cited this work in our study as consistent evidence to support the unrecognized prevalence of primary aldosteronism that had been previously implicated in the pathogenesis of hypertension (1). Although our study protocol controlled many of the regulators and confounders of aldosterone production (including posture, time of day, dietary factors, and some medication classes), we did not suppress adrenocorticotropic ...References1. Brown JM, Robinson-Cohen C, Luque-Fernandez MA, 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. Carey RM, Douglas JG, Schweikert JR, et al. The syndrome of essential hypertension and suppressed plasma renin activity. Normalization of blood pressure with spironolactone. Arch Intern Med. 1972;130:849-54. [PMID: 5082464] CrossrefMedlineGoogle Scholar3. Williams B, MacDonald TM, Morant SV, et al; British Hypertension Society Programme of Prevention And Treatment of Hypertension With Algorithm based Therapy (PATHWAY) Study Group.. Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies. Lancet Diabetes Endocrinol. 2018;6:464-75. [PMID: 29655877] doi:10.1016/S2213-8587(18)30071-8 CrossrefMedlineGoogle Scholar4. Hundemer GL, Curhan GC, Yozamp N, et al. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6:51-9. [PMID: 29129576] doi:10.1016/S2213-8587(17)30367-4 CrossrefMedlineGoogle Scholar5. Agarwal R, Rossignol P, Romero A, et al. Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial. Lancet. 2019;394:1540-50. [PMID: 31533906] doi:10.1016/S0140-6736(19)32135-X CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (A.V., J.M.B., G.H.W.)University of Virginia Health System, Charlottesville, Virginia (R.M.C.)University of Alabama at Birmingham, Birmingham, Alabama (M.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0065. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Unrecognized Prevalence of Primary Aldosteronism Jenifer M. Brown , Mohammed Siddiqui , David A. Calhoun , Robert M. Carey , Paul N. Hopkins , Gordon H. Williams , and Anand Vaidya The Unrecognized Prevalence of Primary Aldosteronism Georgios P. Piaditis , Grigorios Kaltsas , Athina Markou , and George P. Chrousos The Unrecognized Prevalence of Primary Aldosteronism R. Haridian Sosa Barrios , Miriam Menacho-Román , A.L. Mataix , and Fernando Liaño García The Unrecognized Prevalence of Primary Aldosteronism Stefan Pilz , Martin R. Grübler , Verena Theiler-Schwetz , Oliver Malle , and Christian Trummer Metrics Cited byIntrinsic Adrenal TWIK-Related Acid-Sensitive TASK Channel Dysfunction Produces Spontaneous Calcium Oscillations Sufficient to Drive AngII (Angiotensin II)-Unresponsive HyperaldosteronismIncreasing Incidence of Primary Aldosteronism in Western Sweden During 3 Decades – Yet An Underdiagnosed DisorderTrust the Patient: An Unusual Case of Metabolic Alkalosis 20 October 2020Volume 173, Issue 8Page: 683KeywordsAdrenocorticotropic hormoneAldosteroneBlood pressureDisclosureEjection fractionHeart failureHypertensionPathogenesisPostural controlPotassium ePublished: 20 October 2020 Issue Published: 20 October 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...