primary aldosteronism

primary aldosteronism - Combined Plenary Lecture 2 HORMONE...

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Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Combined Plenary Lecture 2 Horm Res 2009;71(suppl 1):8–12 DOI: 10.1159/000178029 ±Primary±Aldosteronism± Robert M. Carey Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, ±Charlottesville,±Va.± ,±USA ±Introduction± Hypertension is one of the world’s leading risk factors for morbidity and mortality and ranks third in disability- adjusted life-years worldwide. In the year 2000, this dis- order affected one quarter of the world’s population – nearly 1 billion people – and its prevalence is projected to increase to 29% by the year 2025. The prevalence of hy- pertension is currently 28% in the United States, 27% in Canada and 38–55% in some European countries. In the United States, hypertension is the most common reason for visiting a physician for ongoing care. Specifically, hy- pertension is a major risk factor for myocardial infarc- tion, congestive heart failure, stroke and end-stage kid- ney disease, though the risk of fatal ischemic heart dis- ease is linked to blood pressure even in the normal range (down to 115/75 mm Hg). Each increase of 20 mm Hg systolic or 10 mm Hg diastolic pressure doubles the risk of a fatal coronary event. Uncontrolled hypertension is a major public health problem. Fewer than one third of hypertensive patients in the United States and Europe meet their blood pressure targets. Yet even among those patients with stage 1 hy- pertension and at least one additional cardiovascular risk factor, sustained lowering of blood pressure by 12 mm Hg for 10 years prevents one death for every 11 patients treat- ed. Thus, the risks of cardiovascular disease can be re- duced with effective antihypertensive therapy. For exam- ple, a decrease of 10 mm Hg in systolic pressure or 5 mm Hg in diastolic pressure is associated with a 40% reduc- Key Words ±Hypertension±± ? Primary aldosteronism ? ±Mineralocorticoid± hormone ? ±Hypokalemia± ±Abstract± Background: Hypertension is one of the world’s leading risk factors for morbidity and mortality. Most affected individuals have primary hypertension, while the most common cause of secondary hypertension is primary aldosteronism (6–10%). Primary Aldosteronism: Clinical manifestations include hy- pertension, hypokalemic alkalosis, renal dysfunction, nephro- genic diabetes insipidus, muscle weakness, paresthesias, teta- ny and, in severe cases, paralysis. The cardiovascular risks for patients with primary aldosteronism are greater than those for patients with primary hypertension. Compared with normo- tensive subjects, patients with primary aldosteronism have a 4.2-fold greater risk of stroke, a 6.5-fold greater risk of myocar- dial infarction and a 12.1-fold greater risk of atrial fibrillation.
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primary aldosteronism - Combined Plenary Lecture 2 HORMONE...

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