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

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.