Abstract

The prevalence of primary aldosterone (PA) among hypertensive patients in referral centers is estimated to be 12%. The prevalence of PA among older subjects in referral populations has not been reported. Screening for PA with the plasma aldosterone concentration (PAC; in ng/ml) to plasma renin activity (PRA; in ng/ml/hr) has led to a dramatic increase in detection and treatment of the disorder. A positive screen for PA in our center is a PAC/PRA > 30.

Using an electronic data base we searched medical records for subjects ≥ 60 years old who had a positive PAC/PRA. Subjects were screened if they had resistant hypertension or hypokalemia. Blood pressure measures taken prior to and following initiation of a treatment regimen including a potassium-sparing diuretic are reported.

Forty patients with a mean age of 65 had a positive screen for PA. Fifty-five percent were white; 75% female. (See Table)

MEANMEAN
Potassium4.0Pre SBP/DBP167/91
Creatinine1.9*MAP115
Aldosterone35Post SBP/DBP143/85
Renin0.2MAP99
PAC/PRA64.8*Mean arterial pressure
MEANMEAN
Potassium4.0Pre SBP/DBP167/91
Creatinine1.9*MAP115
Aldosterone35Post SBP/DBP143/85
Renin0.2MAP99
PAC/PRA64.8*Mean arterial pressure
MEANMEAN
Potassium4.0Pre SBP/DBP167/91
Creatinine1.9*MAP115
Aldosterone35Post SBP/DBP143/85
Renin0.2MAP99
PAC/PRA64.8*Mean arterial pressure
MEANMEAN
Potassium4.0Pre SBP/DBP167/91
Creatinine1.9*MAP115
Aldosterone35Post SBP/DBP143/85
Renin0.2MAP99
PAC/PRA64.8*Mean arterial pressure

PA may be detected in older patients with poorly controlled hypertension. Detection of PA using the PAC/PRA may lead to more effective control in this high-risk population. PA should be considered in the evaluation of resistant hypertension in elderly patients.

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