LAUSR

Objective: Primary aldosteronism is one of the most common causes of secondary hypertension. Despite this, little information is available on routine clinical practice results of confirmatory and subtype testing in patients with suspected primary aldosteronism. Design and method: In patients with suspected primary aldosteronism based on a positive screening test (serum aldosterone/renin ratio > 30 and aldosterone > 100 ng/l) we performed a confirmatory test with an infusion of 2 l of saline within 4 hours. In case of insufficient suppression of aldosterone secretion, the stress test was evaluated as positive and the patient was referred to adrenal vein sampling to determine the laterality of aldosterone secretion. The work was supported by a grant from the Palacký University in Olomouc IGA_LF_2017_029. Results: Confirmatory testing with saline infusion was performed in 312 patients, 190 of whom were men (61%). Mean age of patients in the group was 54 ± 14 years, mean office blood pressure was 145/87 mmHg and they were using on average 4.0 ± 1.8 different antihypertensive drugs. In 277 (89%) of the patients, the confirmatory testing was performed after withdrawal of interfering medications. 82 patients (26%) reported adverse events after the withdrawal of the interfering medications prior testing, most commonly leg edema, fluctuations in blood pressure, weakness, fatigue or headache. Primary aldosteronism was confirmed by the confirmatory test in 110 patients (35%). These patients were referred to adrenal vein sampling, where 39 patients (35%) had unilateral aldosterone secretion (12.3% of all patients with a positive screening test) and 45 patients (41%) had bilateral form. In 26 patients (24%) the subtype of primary aldosteronism was not identified, mostly because of the refusal of invasive examinations or subsequent surgery by the patient. Conclusions: Primary aldosteronism was in routine clinical practice confirmed by saline infusion test in 35% patients with a positive screening test. Every eighth patient (12.3%) with a positive screening test had unilateral disease amenable to surgical treatment.