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Epidemiology and the Need for Screening

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Primary Aldosteronism

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Abstract

Because of change in the accepted meaning of the term “primary aldosteronism” (PA), and in the methods used to screen for and diagnose it, the “perceived” prevalence of PA (and hence the epidemiology of PA) has undergone and is still undergoing progressive change since the first description of PA. As well, methodology for measuring renin and aldosterone has always been not only variable from centre to centre but often suboptimal. Hence in 2013 there existed an understandable, healthy, scientific and clinical lack of complete agreement on the definition of PA, its prevalence and how it is best identified, by screening and definitive tests, and managed. Nevertheless, the prevailing view among clinicians diagnosing and treating significant numbers of PA patients is that it is a common enough cause of hypertension, associated with unusually high morbidity if not treated early, for (1) early detection to be vigorously pursued by screening, with appropriate education of doctors and the community regarding the need to do so; for (2) identification of unilateral disease to have very high priority because surgery yields best patient outcomes and that (3) a recently proposed, “public health” approach involving the addition of “low-dose” aldosterone “antagonists” to first-line treatment of all hypertensive patients is not an appropriate alternative. It would (1) make diagnosis of unilateral PA difficult or impossible, reducing the quality of outcome for up to one-third of patients; (2) make prevalence permanently unknowable; (3) make deciding the appropriate dosage of aldosterone antagonist impossible when interfering medications are also being taken and (4) carry significant hyperkalemic risk. An increasing understanding of the genetic bases of PA holds promise that one day it may be possible to identify not only most PA patients but also a predisposition to PA early enough to prevent or significantly modify its development. In this chapter perceived prevalence is traced chronologically before attempting any estimates of true prevalence in primary and secondary care.

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  1. Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes Hospital, Brisbane, QLD, 4120, Australia

    Richard Douglas Gordon M.B.B.S., M.D., Ph.D., F.R.A.C.P., F.R.C.P.

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  1. Department of Surgery, University Hospital, Uppsala, Sweden

    Per Hellman

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Gordon, R.D. (2014). Epidemiology and the Need for Screening. In: Hellman, P. (eds) Primary Aldosteronism. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0509-6_2

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