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Primary aldosteronism in the primary care setting

Buffolo, Fabrizio; Monticone, Silvia; Tetti, Martina; Mulatero, Paolo

Current Opinion in Endocrinology, Diabetes and Obesity: June 2018 - Volume 25 - Issue 3 - p 155–159
doi: 10.1097/MED.0000000000000408
ADRENAL CORTEX AND MEDULLA: Edited by Anand Vaidya

Purpose of review The aim of the present manuscript is to provide an overview of the most updated studies on the prevalence of primary aldosteronism in primary care and to compare these figures with the actual rate of diagnosis in clinical practice and with the prevalence of primary aldosteronism in specific subgroup of patients.

Recent findings Over the last 20 years the clinical spectrum of low renin hypertension and primary aldosteronism has changed dramatically. Once considered only in the presence of severe hypertension and hypokalemia, it is now well known that primary aldosteronism is not uncommon even in patients with mild forms of hypertension and/or normokalemia. Moreover, recent evidence points toward a large proportion of normotensive study participants as being affected by subclinical primary aldosteronism, which represents a strong risk factor for incident hypertension. Moreover, primary aldosteronism patients are exposed to an increased risk of cardio and cerebrovascular events and metabolic comorbidities compared with patients affected by essential hypertension. Disappointingly, primary aldosteronism remains a largely underdiagnosed and undertreated disorder.

Summary These recent findings further highlight the importance of widening the spectrum of patients who should be screened for primary aldosteronism, to reduce the cardiovascular risk associated with this medical condition.

Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Turin, Italy

Correspondence to Paolo Mulatero, MD, Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy. Tel: +39 0116336959; fax: +39 0116336931; e-mail: paolo.mulatero@unito.it

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