P-628: Primary Aldosteronism (PA) Prevalence in Italy (PAPY) study: Results of a nationwide survey

• Published in: American journal of hypertension 2005-05, Vol.18 (S4), p.235A-235A
• Main Authors: Rossi, Gian Paolo, Bernini, Gianpaolo, Fabris, Bruno, Ferri, Claudio, Ganzaroli, Chiara, Giacchetti, Gilberta, Letizia, Claudio, MacCario, Mauro, Mallamaci, Francesca, Mannelli, Massimo, Palumbo, Gaetana, Rizzoni, Damiano, Rossi, Ermanno, Mantero, Franco
• Format: Article
• Language: English
• Subjects: Nationwide Survey; Prevalence; Primary Aldosteronism
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1016/j.amjhyper.2005.03.645

Background: PA has been contended to be the most common endocrine cause of hypertension (H), but 50 yrs after Dr. Conn's report of the first aldosterone-producing-adenoma (APA), its prevalence in hypertensive patients remains unknown. Objective: To prospectively estimate, with pre-specified diagnostic criteria, the prevalence of PA in newly diagnosed hypertensive patients nationwide in Italy. Design and Methods: Consecutive newly diagnosed (WHO/ISH criteria) hypertensive patients referred to 21 centers for H scattered all over Italy underwent a standard diagnostic protocol, based on measurement of sitting PRA and Aldosterone, baseline and after Captopril (50 mg p.o.), serum Na+ and K, and 24 hr urinary excretion. One every 4 patients and all those with an aldosterone (ng/dl)/PRA (ng/ml/h) ratio >40 and/or > 30, baseline and/or after captopril respectively, and/or with a score of probability of PA (by logistic discriminant function, LDF) >0.50 underwent a standard confirmatory (saline suppression) and an imaging test (CT or MR) for identification of the underlying adrenal pathology. Adrenal vein sampling was also performed whenever necessary. Results: From December 2001 to August 2004, 1094 patients (55% m and 45% f; age: 46±12 yrs) were enrolled. The PA prevalence, calculated according to the aforementioned criteria, was 19.4% and 13.8% using the Aldo/PRA ratio baseline and after captopril, and 27.3% with the LDF score. Of the 980 patients in whom a conclusive diagnosis was eventually made, 7.3% had PA, which was due to an APA in 41 cases (57 %) and to idiopathic PA in the rest. A significant heterogeneity of PA prevalence across centers (p