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Background <p>Primary aldosteronism (PA) is a common but underrecognized cause of secondary hypertension that is associated with a disproportionate cardiovascular risk. We aimed to evaluate the prevalence and predictors of PA among patients with recent (&lt; 3 months) cerebrovascular accident (CVA) treated at our hospital.</p> Methods <p>In this prospective cross-sectional study, 172 patients with a recent CVA were evaluated for PA. Patients with a positive screen [plasma direct renin concentration (DRC) &lt; 12 µIU/mL plus plasma aldosterone concentration (PAC) &gt; 10 ng/dL] underwent recumbent saline infusion test (SIT) and a post-SIT PAC &gt; 5 ng/dL confirmed the diagnosis.</p> Results <p>Eleven (6.4%) patients tested screen positive, of whom two had severe PA (PAC &gt; 20 ng/dL, suppressed renin and hypokalemia). The remaining nine patients underwent confirmatory test, and all had elevated post-SIT PAC &gt; 5 ng/dL, thus accounting for an overall PA prevalence of 6.4%. The prevalence of PA sharply increased with the number of antihypertensive medications used (3.2% in those taking ≤ 1 medication to 25% in those taking ≥ 4 medications) and decreasing serum potassium levels (0% in those with serum potassium &gt; 5 mmol/L to 30% in those with serum potassium &lt; 3.5 mmol/L).</p> Conclusion <p>The overall prevalence of PA in our cohort was 6.4%. PA should be suspected and screened in patients with CVA, especially in the setting of hypokalemia and increased antihypertensive requirements.</p>

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Prevalence of primary aldosteronism among patients with a history of recent cerebrovascular accident

  • 期刊论文

  • 发表日期：

    2025年10月15日

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  • Manish Thakur,
  • Alpesh Goyal,
  • Manasvini Bhatt,
  • Rohit Bhatia,
  • Sarah Alam,
  • Rajesh Khadgawat

摘要

Background

Primary aldosteronism (PA) is a common but underrecognized cause of secondary hypertension that is associated with a disproportionate cardiovascular risk. We aimed to evaluate the prevalence and predictors of PA among patients with recent (< 3 months) cerebrovascular accident (CVA) treated at our hospital.

Methods

In this prospective cross-sectional study, 172 patients with a recent CVA were evaluated for PA. Patients with a positive screen [plasma direct renin concentration (DRC) < 12 µIU/mL plus plasma aldosterone concentration (PAC) > 10 ng/dL] underwent recumbent saline infusion test (SIT) and a post-SIT PAC > 5 ng/dL confirmed the diagnosis.

Results

Eleven (6.4%) patients tested screen positive, of whom two had severe PA (PAC > 20 ng/dL, suppressed renin and hypokalemia). The remaining nine patients underwent confirmatory test, and all had elevated post-SIT PAC > 5 ng/dL, thus accounting for an overall PA prevalence of 6.4%. The prevalence of PA sharply increased with the number of antihypertensive medications used (3.2% in those taking ≤ 1 medication to 25% in those taking ≥ 4 medications) and decreasing serum potassium levels (0% in those with serum potassium > 5 mmol/L to 30% in those with serum potassium < 3.5 mmol/L).

Conclusion

The overall prevalence of PA in our cohort was 6.4%. PA should be suspected and screened in patients with CVA, especially in the setting of hypokalemia and increased antihypertensive requirements.