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Primary aldosteronism is a public health issue: challenges and opportunities

Journal of Human Hypertension volume 34, pages 478–486 (2020)Cite this article

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Abstract

A significant proportion of hypertension (potentially more than 5% in the general population) is due to primary aldosteronism (PA) which carries a worse prognosis when compared with blood pressure-matched essential hypertension. Effective targeted treatments are available which mitigate many of the cardiovascular complications of untreated PA. Despite this, the detection rate of PA in primary care is sub-optimal. In this review, we explore the challenges contributing to the under-diagnosis of PA in the community, including uncertainties regarding its actual prevalence. In order to detect PA early and offer targeted treatment before adverse cardiovascular consequences develop, routine screening for PA at the time of a diagnosis of hypertension would seem desirable. However, this is limited by a lack of studies to establish whether routine screening in primary care is cost-effective. Newer techniques are also being developed which could lessen the complexity of diagnosing PA. Most importantly, a dramatic increase in awareness of PA, as a treatable cause of hypertension, is needed amongst clinicians who manage hypertension.

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Fig. 1: Challenges and future directions in PA diagnosis.
Fig. 2

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Notes

  1. All measurements have been converted into SI units using the following conversion: PAC 1  ng/dL =  27.7 pmol/L; direct renin concentration (DRC) 1  ng/L = 1.6 mU/L; and plasma renin activity (PRA) 1  ng/mL/h  =  DRC 8.2 mU/L.

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Funding

RL is supported by NHMRC/National Heart Foundation postgraduate scholarship and RACP. JY is supported by project funding from the Endocrine Society of Australia, CASS Foundation, Heart Foundation (Vanguard Grant) and Council for High Blood Pressure Research Australia.

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Authors and Affiliations

  1. Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC, Australia

    Renata Libianto, Peter J. Fuller, Morag J. Young & Jun Yang

  2. Department of Endocrinology, Monash Health, Melbourne, VIC, Australia

    Renata Libianto, Peter J. Fuller & Jun Yang

  3. Department of Medicine, Monash University, Melbourne, VIC, Australia

    Renata Libianto, Peter J. Fuller, Morag J. Young & Jun Yang

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Libianto, R., Fuller, P.J., Young, M.J. et al. Primary aldosteronism is a public health issue: challenges and opportunities. J Hum Hypertens 34, 478–486 (2020). https://doi.org/10.1038/s41371-020-0336-2

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