FP40-3 Prevalence of primary aldosteronism depends on the means of case detection: prospective multi-center study of National Hospital Organization in Japan (PHAS-J2)

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP40-Renin-Angiotensin-Aldosterone System/Endocrine Hypertension
Basic/Translational
Monday, June 17, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 10:55 AM
Room 135 (Moscone Center)

Poster Board MON-727
Mitsuhide Naruse*1, Yasushi Miyazaki2, Takeshi Tanaka3, Masatoshi Shimizu4, Sumire Otani5, Shirou Hata6, Atsushi Ogo7, Kazuya Yonezawa8, Kazuo Yoshida9, Morio Sawamura10, Rika Araki11, Makito Tanabe12, Mika Tsuiki13, Aya Tsumagari1, Kazutaka Nanba1, Tomoko Suzuki14, Takurou Shimbo14 and Study PHASJ215
1National Hospital Organization Kyoto Medical Center, Kyoto, Japan, 2Misato Kenwa Hospital, Saitama, Japan, 3NHO Mie Chuou Medical Center, Japan, 4NHO Kobe Medical Center, Japan, 5National Saitama Hospital, Saitama, Japan, 6Nagasaki Goto Chuoh Hospital, Goto, Japan, 7Kyushu Medical Center, KItakyushu, Japan, 8Hakodate Hospital, Hakodate, Japan, 9Nagasaki Kawatana Hospital, Kawatana, Japan, 10Nishigunma Hospital, Shibukawa, Japan, 11Mie Hospital, Tsu, Japan, 12Natl Hosp Org Kokura Hosp, Kitakyushu, Japan, 13National Hospital Organization Kyoto Medical Center, Tokyo, Japan, 14National International Research Center, Tokyo, Japan, 15Kyoto Medical Center, Kyoto, Japan
Primary aldosteronism (PA) is one of the major causes of secondary hypertension. The guideline for PA by the Endocrine Society recommends case detection, confirmatory testing, and subtype classification as the essential process. Given that patients with positive case detection are recommended to receive further investigation by the guideline, means of the case detection as the first step have a deep impact on the general clinical practice of hypertensive patients. Aim of the study was to investigate the effects of different means of case detection on the prevalence of PA in patients with hypertension. The study was conducted as the multi-center collaborative study of the National Hospital Organization (NHO) in Japan (PHAS-J2). Total 25 NHO and collaborated city hospitals with beds from 280 to 700 participated into the study. The study was approved by the institutional ethical committee. Patients with hypertension (20 to 75 yrs.) were enrolled. Four different means were used for case detection: 1) Plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio (ARR) with a cutoff of 20, 2) ARR>20 and PAC>10ng/dl, 3) ARR>20 and PAC>15ng/dl, and 4) ARR>20, PAC>15ng/dl and PRA<1.0, respectively. Captopril challenge test was used as a confirmatory testing in patients with positive case detection. Total 1546 patients were enrolled. Case detection was positive in 23.2% with ARR only, 16.9% with ARR+PAC (>10 ng/dl), 9.9% with ARR+PAC (>15ng/dl), and 9.2% with ARR+PAC (>15ng/dl)+PRA, respectively. Confirmatory testing with captopril challenge test was positive in 58%, 60.4%, 65.9%, and 68.5% of the patients positive for respective means of case detection. Collectively, prevalence of PA in hypertension was 13.5%, 10.2%, 6.52%, and 6.36%, respectively, with the respective means of case detection. The present study of the NHO in Japan clearly demonstrated that the positive rate of case detection and prevalence of PA showed a wide variation depending on the means of case detection. Given that PA is very common in hypertension, further studies are required to optimize the means of case detection in terms of the long term prognosis and medical cost.

Nothing to Disclose: MN, YM, TT, MS, SO, SH, AO, KY, KY, MS, RA, MT, MT, AT, KN, TS, TS, SP

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Research Grant from the National Hospital Organization