Hyperaldosteronism Among Black and White Subjects With Resistant Hypertension
Abstract
Recent reports suggesting that the prevalence of primary hyperaldosteronism may be higher than historically thought have relied on an elevated plasma aldosterone concentration/plasma renin activity ratio to either diagnose or identify subjects at high risk of having primary hyperaldosteronism and have not included suppression testing of all evaluated subjects. In this prospective study of 88 consecutive patients referred to a university clinic for resistant hypertension, we determined the 24-hour urinary aldosterone excretion during high dietary salt ingestion, baseline plasma renin activity, and plasma aldosterone in all subjects. Primary hyperaldosteronism was confirmed if plasma renin activity was <1.0 ng/mL per hour and urinary aldosterone was >12 μg/24-hour during high urinary sodium excretion (>200 mEq/24-hour). Eighteen subjects (20%) were confirmed to have primary hyperaldosteronism. The prevalence of hyperaldosteronism was similar in black and white subjects. Of the 14 subjects with confirmed hyperaldosteronism who have been treated with spironolactone, all have manifested a significant reduction in blood pressure. In this population, an elevated plasma aldosterone/plasma renin activity ratio (>20) had a sensitivity of 89% and a specificity of 71% with a corresponding positive predictive value of 44% and a negative predictive value of 96%. These data provide strong evidence that hyperaldosteronism is a common cause of resistant hypertension in black and white subjects. The accuracy of these results is strengthened by having done suppression testing of all evaluated subjects.
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The majority of studies indicate that primary aldosteronism is a particularly common cause of resistant hypertension.
“The majority of studies indicate that primary aldosteronism is a particularly common cause of RH.”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [295]
Observational studies from many different countries have demonstrated a prevalence rate of primary aldosteronism of ≈20% in patients with confirmed resistant hypertension.
“Observational studies from many different countries have demonstrated a prevalence rate of primary aldosteronism of ≈20% in patients with confirmed RH.57,160,294–296”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [295]
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- Authors
- Calhoun, D. A., Nishizaka, M. K., Zaman, M. A., Thakkar, R. B., & Weissmann, P.
- Affiliations
- Trinity Health Michigan (US)
- ORCID
- Calhoun, David A.
- Venue
- Hypertension
- Published
- 2002-12
- Volume
- 40
- Issue
- 6
- Pages
- 892-896
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2129950671
- Cited by
- 763
- References
- 33
- Citations by year
- 2026: 20 · 2025: 31 · 2024: 24 · 2023: 28 · 2022: 34 · 2021: 24 · 2020: 38 · 2019: 35 · 2018: 19 · 2017: 32 · 2016: 34 · 2015: 36 · 2014: 43 · 2013: 36 · 2012: 39
- FWCI
- 10.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- University of Alabama at Birmingham
- National Heart, Lung, and Blood Institute (HL-07457+, T32HL007457)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
- Keywords
- primary aldosteronism, resistant hypertension, aldosterone-renin ratio, urinary aldosterone excretion, plasma renin activity, spironolactone, diagnostic accuracy, prevalence, racial differences, Black and White patients
- MeSH terms
- Adult, Aged, Aged, 80 and over, Alabama, Aldosterone, Mineralocorticoid Receptor Antagonists, Black or African American, Blood Pressure, Diuretics, Drug Resistance, Female, Humans, Hyperaldosteronism, Hypertension, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Renin, Sensitivity and Specificity, Spironolactone, Prevalence, Sodium Chloride, Dietary, Black People, White People
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