Hypertension: a curable cause for a lifetime condition?

  • Yang S & al.
  • JAMA Intern Med
  • 16/03/2020

  • Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Primary aldosteronism can be a cause of secondary hypertension, and clinicians need to be aware of when to evaluate for this possibility, say these authors.
  • In fact, it can be the culprit in up to 1 in 10 cases of hypertension, presenting a curable cause.

Why this matters

  • Guidelines call for clinicians to evaluate for primary aldosteronism if hypertension remains severe despite triple concurrent therapy or if 4 or more drugs are required to control it.

Key comments

  • In addition to resistant hypertension, other hints at primary aldosteronism in patients with hypertension are hypokalemia, sleep apnea, or a family history of early-onset hypertension or primary aldosteronism.
  • The authors describe a case of a woman, age 63 years, with 3-decade history of hypertension.
    • She was taking 3 medications without controlled BP.
    • History of stroke 15 years before.
    • Testing showed hypokalemia, which persisted despite cessation of diuretic, triggering evaluation for primary aldosteronism, which was confirmed.
    • The condition was the result of a CT-identified left adrenal adenoma, which was removed.
    • Removal returned her BP to normal, allowing discontinuation of all antihypertensives.
    • The authors suggest that had screening been done appropriately and her primary condition treated, she might have been spared the stroke. 
  • They note that about 15% of patients with hypertension have it secondary to some primary condition.
  • A decision-making flowchart is included.