Taweesak Wannachalee1,2, Leedor Lieberman1, Adina F Turcu3. 1. Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, 1150 W Medical Center Drive, MSRB II, 5570B, Ann Arbor, MI, 48109, USA. 2. Division of Endocrinology and Metabolism, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 3. Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, 1150 W Medical Center Drive, MSRB II, 5570B, Ann Arbor, MI, 48109, USA. aturcu@umich.edu.
Abstract
PURPOSE OF REVIEW: Primary aldosteronism (PA) affects millions of individuals worldwide. When unrecognized, PA leads to cardiovascular and renal complications via mechanisms independent from those mediated by hypertension. In this review, we emphasize the importance of PA screening in at-risk populations, and we provide options for customized PA therapy, with consideration for a variety of clinical care settings. RECENT FINDINGS: Compelling evidence puts PA at the forefront of secondary hypertension etiologies. Cardiovascular and renal damage likely begins in early stages of renin-independent aldosterone excess. PA must be considered not only in patients with resistant hypertension or hypokalemia, but also when hypertension is associated with obstructive sleep apnea or atrial fibrillation, or in those with early-onset hypertension. Screening with plasma aldosterone and renin is widely accessible, and targeted PA therapy can successfully circumvent the excess cardiorenal risk relative to equivalent primary hypertension. Identifying and treating PA in early stages provide opportunities for personalized hypertension therapy in a large number of patients. Additionally, early targeted therapy of PA is essential for pivoting the care of such patients from reactive to preventive of cardiovascular and renal morbidity and mortality.
PURPOSE OF REVIEW: Primary aldosteronism (PA) affects millions of individuals worldwide. When unrecognized, PA leads to cardiovascular and renal complications via mechanisms independent from those mediated by hypertension. In this review, we emphasize the importance of PA screening in at-risk populations, and we provide options for customized PA therapy, with consideration for a variety of clinical care settings. RECENT FINDINGS: Compelling evidence puts PA at the forefront of secondary hypertension etiologies. Cardiovascular and renal damage likely begins in early stages of renin-independent aldosterone excess. PA must be considered not only in patients with resistant hypertension or hypokalemia, but also when hypertension is associated with obstructive sleep apnea or atrial fibrillation, or in those with early-onset hypertension. Screening with plasma aldosterone and renin is widely accessible, and targeted PA therapy can successfully circumvent the excess cardiorenal risk relative to equivalent primary hypertension. Identifying and treating PA in early stages provide opportunities for personalized hypertension therapy in a large number of patients. Additionally, early targeted therapy of PA is essential for pivoting the care of such patients from reactive to preventive of cardiovascular and renal morbidity and mortality.
Authors: Mohammad H Forouzanfar; Patrick Liu; Gregory A Roth; Marie Ng; Stan Biryukov; Laurie Marczak; Lily Alexander; Kara Estep; Kalkidan Hassen Abate; Tomi F Akinyemiju; Raghib Ali; Nelson Alvis-Guzman; Peter Azzopardi; Amitava Banerjee; Till Bärnighausen; Arindam Basu; Tolesa Bekele; Derrick A Bennett; Sibhatu Biadgilign; Ferrán Catalá-López; Valery L Feigin; Joao C Fernandes; Florian Fischer; Alemseged Aregay Gebru; Philimon Gona; Rajeev Gupta; Graeme J Hankey; Jost B Jonas; Suzanne E Judd; Young-Ho Khang; Ardeshir Khosravi; Yun Jin Kim; Ruth W Kimokoti; Yoshihiro Kokubo; Dhaval Kolte; Alan Lopez; Paulo A Lotufo; Reza Malekzadeh; Yohannes Adama Melaku; George A Mensah; Awoke Misganaw; Ali H Mokdad; Andrew E Moran; Haseeb Nawaz; Bruce Neal; Frida Namnyak Ngalesoni; Takayoshi Ohkubo; Farshad Pourmalek; Anwar Rafay; Rajesh Kumar Rai; David Rojas-Rueda; Uchechukwu K Sampson; Itamar S Santos; Monika Sawhney; Aletta E Schutte; Sadaf G Sepanlou; Girma Temam Shifa; Ivy Shiue; Bemnet Amare Tedla; Amanda G Thrift; Marcello Tonelli; Thomas Truelsen; Nikolaos Tsilimparis; Kingsley Nnanna Ukwaja; Olalekan A Uthman; Tommi Vasankari; Narayanaswamy Venketasubramanian; Vasiliy Victorovich Vlassov; Theo Vos; Ronny Westerman; Lijing L Yan; Yuichiro Yano; Naohiro Yonemoto; Maysaa El Sayed Zaki; Christopher J L Murray Journal: JAMA Date: 2017-01-10 Impact factor: 56.272
Authors: Paul Muntner; Robert M Carey; Samuel Gidding; Daniel W Jones; Sandra J Taler; Jackson T Wright; Paul K Whelton Journal: Circulation Date: 2017-11-13 Impact factor: 29.690
Authors: Paul Muntner; Shakia T Hardy; Lawrence J Fine; Byron C Jaeger; Gregory Wozniak; Emily B Levitan; Lisandro D Colantonio Journal: JAMA Date: 2020-09-22 Impact factor: 56.272
Authors: Sabine C Käyser; Tanja Dekkers; Hans J Groenewoud; Gert Jan van der Wilt; J Carel Bakx; Mark C van der Wel; Ad R Hermus; Jacques W Lenders; Jaap Deinum Journal: J Clin Endocrinol Metab Date: 2016-05-12 Impact factor: 5.958
Authors: Paolo Mulatero; Michael Stowasser; Keh-Chuan Loh; Carlos E Fardella; Richard D Gordon; Lorena Mosso; Celso E Gomez-Sanchez; Franco Veglio; William F Young Journal: J Clin Endocrinol Metab Date: 2004-03 Impact factor: 5.958
Authors: John W Funder; Robert M Carey; Franco Mantero; M Hassan Murad; Martin Reincke; Hirotaka Shibata; Michael Stowasser; William F Young Journal: J Clin Endocrinol Metab Date: 2016-03-02 Impact factor: 5.958