February 2024
Subsequent development of primary aldosteronism after negative testing

Five years after a negative confirmatory test, 20% of patients with arterial hypertension had developed overt primary aldosteronism.

Primary aldosteronism is a secondary cause of hypertension that is often treatable. The first diagnostic test used to screen for primary aldosteronism is an aldosterone-to-renin ratio. If this is abnormal, a confirmatory test is usually performed, the results of which are negative in approximately 50 to 70% of patients. In order to understand the future health outcomes of such individuals, investigators enrolled 184 patients with arterial hypertension and a previously abnormal elevated aldosterone-to-renin ratio followed by a negative confirmatory test.

After a mean follow up of five years since the original negative confirmatory test, the patients were rescreened and then underwent either a seated saline infusion test or captopril challenge test for confirmation of primary aldosteronism. The results showed that 20% of patients had developed overt primary aldosteronism.

In these patients, despite receiving similar antihypertensive therapy to those without primary aldosteronism, blood pressure control was worse and cardiac organ damage more common.

Comment: Primary aldosteronism is probably much more common than previously believed, especially in patients with resistant hypertension. These data verify that we should continue to follow patients with suspected primary aldosteronism who have a positive screening test followed by a negative confirmatory test. In my practice, I will not only follow these patients but will repeat primary aldosteronism testing if blood pressure remains difficult to control.

Karol E. Watson, MD, PhD, FACC, John C. Mazziotta, MD, PhD, Term Endowed Chair and Professor of Medicine/Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, USA.

Buffolo F, et al. Long-term follow-up of patients with elevated aldosterone-to- renin ratio but negative confirmatory test: the progression of primary aldosteronism phenotypes. Hypertension 2023 Dec 12; e-pub (https://doi.org/10.1161/ HYPERTENSIONAHA.123.21983).

This summary is taken from the following Journal Watch title: Cardiology.