For the two primary outcomes, patients with primary aldosteronism had an increased risk of stroke (OR 2.58, 95%CI 1.93–3.45) and coronary artery disease (1.77, 1.10–2.83).
A commentary notes that the median age at presentation in both cohorts was 53 years, the duration of known hypertension a median of almost 9 years, and 28% of those patients with primary aldosteronism and 32% of those with essential hypertension were female; in addition, the median serum potassium concentration among patients with primary aldosteronism was 3·3 mEq/L. It adds that given these studies took place during a period of more than 30 years, with only three of the 31 done in the past decade, the data are historical rather than contemporary. Furthermore, none of the distinguishing characteristics of the study population (age at presentation, duration of known hypertension, male preponderance, and hypokalaemia) should be the case today, as evident from a study comparing results from 12 expert centres. It suggests that plasma renin should be measured in all newly presenting people with hypertension and if renin <1·0 μg/L per h (or plasma renin concentration equivalently supressed), patients should proceed straight to screening for primary aldosteronism.
This report is one of two published in the journal that are of particular relevance to the clinical management of primary aldosteronism. The other report charts cardiometabolic outcomes and mortality post-intervention, primarily in medically treated patients, but with additional reference to those with unilateral disease treated surgically. It found that the current practice of mineralocorticoid receptor antagonists therapy in primary aldosteronism is associated with significantly higher risk for incident cardiometabolic events and death, independent of blood pressure control, than for patients with essential hypertension.