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Evidence of Primary Aldosteronism in a Predominantly Female Cohort of Normotensive Individuals: A Very High Odds Ratio for Progression into Arterial Hypertension
Abstract
CONTEXT: Primary aldosteronism (PA) is an established cause of hypertension, whereas high-normal serum aldosterone levels have been linked to an increased risk for hypertension. OBJECTIVE: We aimed to define the post-fludrocortisone-dexamethasone suppression test (FDST) normal cutoff values of aldosterone and the aldosterone to renin ratio and evaluate the presence of PA in normotensive individuals. DESIGN: This study was designed as a case-control study. SETTING: The study was performed in a tertiary general hospital. PATIENTS: One hundred normotensive participants (80 females), mean age 53 years, were studied. MAIN OUTCOME MEASURES: All participants underwent baseline biochemical and hormonal evaluation, FDST, and adrenal computerized tomography. Blood pressure was assessed at baseline and after 5 years. RESULTS: Sixty-nine participants with normal adrenal computerized tomography who remained normotensive after 5 years were used as a control population to calculate the cutoff values of adequate aldosterone suppression. PA was defined as a combination of post-FDST aldosterone to renin ratio of 0.93 ng/dL · μU/mL or greater (100% sensitivity and 96% specificity) and post-FDST aldosterone of 2.96 ng/dL or greater (100% sensitivity and 61% specificity on receiver-operating characteristic analysis). Thirteen of 100 participants had PA at baseline and 11 (85%) developed hypertension, whereas only 20 of 87 without PA (23%) developed hypertension at 5 years [odds ratio (OR) 18.42, 95% confidence intervals (CI) 3.76-90.10, P < .0001]. Logistic regression analysis showed a positive relation of PA [odds ratio (OR) 16.30, confidence interval (CI) 1.78-150.30, P = .01] and a negative relation of serum potassium (OR 0.39, CI 0.19-0.79, P = .01) with the development of hypertension. CONCLUSIONS: Normotensive PA represents a clinical entity referring to normotensive individuals with PA who are at increased risk for hypertension.
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“A few publications have reported normotensive PA in AI; however, most of these patients demonstrated occasional hypokalemia (8,272-274).”
From Adrenal incidentaloma (2020) · cites this paper as [272]
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Metadata
- Authors
- Markou, A., Pappa, T., Kaltsas, G., Gouli, A., Mitsakis, K., Tsounas, P., Prevoli, A., Tsiavos, V., Papanastasiou, L., Zografos, G., Chrousos, G. P., & Piaditis, G. P.
- Affiliations
- Department of Endocrinology and Diabetes Center (A.M., T.P., A.G., K.M., P.T., A.P., V.T., L.P., G.P.P.), 11527 Athens, Greece
- General Hospital of Athens G. Genimatas (GR)
- Third Department of Surgery (G.Z.), 11527 Athens, Greece
- National and Kapodistrian University of Athens (GR)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2013-04-01
- Volume
- 98
- Issue
- 4
- Pages
- 1409-1416
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2007085386
- Cited by
- 112
- References
- 41
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 10 · 2023: 7 · 2022: 8 · 2021: 14 · 2020: 15 · 2019: 9 · 2018: 9 · 2017: 16 · 2016: 2 · 2015: 1 · 2014: 2
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- 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 › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- primary aldosteronism, normotensive subjects, hypertension progression, aldosterone-renin ratio, serum aldosterone, cut-off values, serum potassium, adrenal imaging, women
- MeSH terms
- Adult, Aged, Aldosterone, Blood Pressure, Dexamethasone, Diagnostic Techniques, Endocrine, Female, Fludrocortisone, Humans, Hyperaldosteronism, Hypertension, Male, Middle Aged, Sex Ratio, Cohort Studies, Odds Ratio, Case-Control Studies, Disease Progression
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