Prevalence of Hyperaldosteronism in Primary Care Patients with Resistant Hypertension

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Figure 1.
Patient flow. *Cessation of ß blocker/spironolactone not possible because of organizational barriers, patients' characteristics and other barriers. ARR, aldosterone-renin ratio.

Table 1.

Laboratory Results of 63 Primary Care Patients With Resistant Hypertension

	Resistant Hypertension	Resistant Hypertension and Elevated ARR	P
Patients (n)	63	15
Age (mean years [SD])	69.2 (10.4)	64.8 (12.0)	.208^*
Female (n [%])	44 (69.8)	10 (66.7)
Retired (n [%])	53 (84.1)	11 (73.3)
White (n [%])	100 (10.0)	100 (10.0)
SHI (n [%])	62^‡ (98.4)	15 (100)
BMI (kg/m²) (mean [SD])	31.3 (5.5)	30.9 (5.3)	.762^*
ACE inhibitors (n [%])	58 (92.1)	13 (86.7)
ABA (n [%])	53 (84.0)	15 (100)
CCB (n [%])	37 (58.7)	5 (33.3)
AAA (n [%])	9 (14.3)	3 (20.0)
Diuretics (n [%])	61 (96.8)	14 (93.3)
Creatinine (mean mg/dl [SD])	0.97 (0.23)	0.98 (0.19)	.816^*
Potassium (mean mEq/l [SD])	4.3 (0.47)	4.1 (0.52)	.245^*
Aldosterone (median pg/mL [IQR])
With β-blocker	109 (73.0–168.0) (n = 29)	157 (116.5–202.5) (n = 11)	.076^†
Without β-blocker	108 (52.5–140.8) (n = 34)	180 (138.2–204.5) (n = 4)	.122^†
Renin (median pg/mL [IQR])
With β-blocker	5.6 (3.0–24.1, n = 29)	1.2 (1.1–2.2) (n = 11)	<.001^†
Without β-blocker	9.0 (4.2–29.5, n = 34)	1.0 (0.9–1.2) (n = 4)	.005^†
ARR (median [IQR])
With β-blocker	17.1 (6.0–36.5, n = 29)	106.2 (68.1–177.5) (n = 11)	<.001^†
Without β-blocker	8.9 (3.9–24.1, n = 34)	137.1 (100.0–186.5) (n = 4)	.005^†

↵* t test.
↵† Wilcoxon rank-sum test.
↵‡ The remaining patient had private insurance.
AAA, adrenergic alpha- antagonists; ABA, adrenergic beta-antagonists; ACE, angiotensin-converting enzyme; ARR, aldosterone-renin ratio; BMI, body mass index; CCB, calcium channel blocker; IQR, interquartile range; SD, standard deviation; SHI, social health insurance by statute.

Table 2.

Prevalence of Hyperaldosteronism (Elevated Aldosterone-Renin Ratio [ARR] and Elevated Aldosterone) in Different Subgroups

Prevalence of Hyperaldosteronism	Percentage
Total patients (n = 3107)	0.09
Patients with hypertension (n = 566)	0.53
Patients with resistant hypertension (n = 79)	3.8
Patients with resistant hypertension and elevated ARR (n = 15)	20.0