The DOI matches its Crossref record; 57 of the 57 references it cites were found in a registry or an index.
The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study
Open accessAbstract
BACKGROUND: Primary aldosteronism is a nonsuppressible renin-independent aldosterone production that causes hypertension and cardiovascular disease. OBJECTIVE: To characterize the prevalence of nonsuppressible renin-independent aldosterone production, as well as biochemically overt primary aldosteronism, in relation to blood pressure. DESIGN: Cross-sectional study. SETTING: 4 U.S. academic medical centers. PARTICIPANTS: = 408). MEASUREMENTS: Participants completed an oral sodium suppression test, regardless of aldosterone or renin levels, as a confirmatory diagnostic for primary aldosteronism and to quantify the magnitude of renin-independent aldosterone production. Urinary aldosterone was measured in participants in high sodium balance with suppressed renin activity. Biochemically overt primary aldosteronism was diagnosed when urinary aldosterone levels were higher than 12 μg/24 h. RESULTS: Every blood pressure category had a continuum of renin-independent aldosterone production, where greater severity of production was associated with higher blood pressure, kaliuresis, and lower serum potassium levels. Mean adjusted levels of urinary aldosterone were 6.5 μg/24 h (95% CI, 5.2 to 7.7 μg/24 h) in normotension, 7.3 μg/24 h (CI, 5.6 to 8.9 μg/24 h) in stage 1 hypertension, 9.5 μg/24 h (CI, 8.2 to 10.8 μg/24 h) in stage 2 hypertension, and 14.6 μg/24 h (CI, 12.9 to 16.2 μg/24 h) in resistant hypertension; corresponding adjusted prevalence estimates for biochemically overt primary aldosteronism were 11.3% (CI, 5.9% to 16.8%), 15.7% (CI, 8.6% to 22.9%), 21.6% (CI, 16.1% to 27.0%), and 22.0% (CI, 17.2% to 26.8%). The aldosterone-renin ratio had poor sensitivity and negative predictive value for detecting biochemically overt primary aldosteronism. LIMITATION: Prevalence estimates rely on arbitrary and conventional thresholds, and the study population may not represent nationwide demographics. CONCLUSION: The prevalence of primary aldosteronism is high and largely unrecognized. Beyond this categorical definition of primary aldosteronism, there is a prevalent continuum of renin-independent aldosterone production that parallels the severity of hypertension. These findings redefine the primary aldosteronism syndrome and implicate it in the pathogenesis of "essential" hypertension. PRIMARY FUNDING SOURCE: National Institutes of Health.
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Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.11.006 · Cited by 6,616
Self-citationMills, K. T., Bundy, J. D., Kelly, T. N., Reed, J. E., Kearney, P. M., Reynolds, K., Chen, J., & He, J. (2016) · Circulation · doi:10.1161/circulationaha.115.018912 · Cited by 3,531
Funder, J. W., Carey, R. M., Mantero, F., Murad, M. H., Reincke, M., Shibata, H., Stowasser, M., & Young, W. F. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-4061 · Cited by 2,925
Self-citationA prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients
Rossi, G. P., Bernini, G., Caliumi, C., Desideri, G., Fabris, B., Ferri, C., Ganzaroli, C., Giacchetti, G., Letizia, C., Maccario, M., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.07.059 · Cited by 1,467
Williams, B., MacDonald, T. M., Morant, S., Webb, D. J., Sever, P., McInnes, G., Ford, I., Cruickshank, J. K., Caulfield, M. J., Salsbury, J., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)00257-3 · Cited by 1,308
Carey, R. M., Calhoun, D. A., Bakris, G. L., Brook, R. D., Daugherty, S. L., Dennison-Himmelfarb, C. R., Egan, B. M., Flack, J. M., Gidding, S. S., Judd, E., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000084 · Cited by 1,153
Self-citationMonticone, S., D'Ascenzo, F., Moretti, C., Williams, T. A., Veglio, F., Gaita, F., & Mulatero, P. (2018) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30319-4 · Cited by 1,072
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2018.06.010 · Cited by 947
Self-citationWhelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000597 · Cited by 902
Self-citationUrinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events
O'Donnell, M., Mente, A., Rangarajan, S., McQueen, M. J., Wang, X., Liu, L., Yan, H., Lee, S. F., Mony, P., Devanath, A., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1311889 · Cited by 886
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2024 ESC Guidelines for the management of elevated blood pressure and hypertension
McEvoy, J. W., McCarthy, C. P., Bruno, R. M., Brouwers, S., Canavan, M. D., Ceconi, C., Christodorescu, R. M., Daskalopoulou, S. S., Ferro, C. J., Gerdts, E., et al. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae178 · Cited by 2,298
Pathophysiology of Hypertension: The Mosaic Theory and Beyond
Harrison, D. G., Coffman, T. M., & Wilcox, C. S. (2021) · Circulation Research · doi:10.1161/circresaha.121.318082 · Cited by 365
Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline
Adler, G. K., Stowasser, M., Correa, R. R., Khan, N., Kline, G., McGowan, M. J., Mulatero, P., Murad, M. H., Touyz, R. M., Vaidya, A., et al. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf284 · Cited by 355
Self-citationJones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., et al. (2025) · JACC · doi:10.1016/j.jacc.2025.05.007 · Cited by 280
Chaudhuri, A., Ghanim, H., & Arora, P. (2022) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.14601 · Cited by 120
“these effects of aldosterone do not require elevated serum aldosterone levels,(33) recent studies have shown that the majority of patients with hypertension have high aldosterone levels.(34)”
Background
Metadata
- Authors
- Brown, J. M., Siddiqui, M., Calhoun, D. A., Carey, R. M., Hopkins, P. N., Williams, G. H., & Vaidya, A.
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2020-07-07
- Volume
- 173
- Issue
- 1
- Pages
- 10-20
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W3171708529
- Cited by
- 649
- References
- 57
- FWCI
- 49.04
- Type
- journal article
- Language
- en
- Open access
- green
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- Brown, J. M., Siddiqui, M., Calhoun, D. A., Carey, R. M., Hopkins, P. N., Williams, G. H., & Vaidya, A. (2020). The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study. Annals of Internal Medicine. https://doi.org/10.7326/m20-0065
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