BREAKING! High Blood Pressure: Study Shows Current Approach Towards Hypertension Totally Flawed As Aldosteronism May Be A Bigger Contributing Factor
Source: High Blood Pressure -Hypertension May 28, 2020 4 years, 5 months, 3 weeks, 5 days, 13 hours, 32 minutes ago
High Blood Pressure: Based on a new study Harvard Medical School Brigham and Women's Hospital, a hormonal condition known as aldosteronism could be contributing to the growing number of individuals suffering from high blood pressure or hypertension without them or their doctors knowing of it.
This frequently not detected hormonal condition called primary aldosteronism, arises when the adrenal glands overproduce the hormone aldosterone. That causes the body to retain sodium and lose potassium, spurring a spike in blood pressure.
Although physicians have long considered the condition an uncommon cause of high blood pressure many simply do not test for it.
The new research showed that about 22% of patients with more severe high blood pressure had primary aldosteronism. The same was true of almost 16% of patients with milder, stage 1 high blood pressure.
The study findings suggests doctors need to "redefine" the traditional view of primary aldosteronism, as far from being rare, it appears to be a common cause of high blood pressure.
The research findings were published online in the
Annals of Internal Medicine. The study was funded by the U.S. National Institutes of Health.
https://www.acpjournals.org/doi/10.7326/M20-0065
According to Dr John Funder, a distinguished scientist with the Hudson Institute of Medical Research, in Melbourne, Australia, the study is a "game changer."
Dr Funder said it shows that the way healthcare professionals have been screening for primary aldosteronism for decades which does not provide the true story.
Dr Funder, who wrote an editorial published with the findings, said the standard screening method is "fatally flawed."
Typically, it is done via a single blood draw, taken in the morning. But aldosterone levels, like those of other hormones, fluctuate over the course of a day. So that single blood measurement, Dr Funder explained, does not capture a person's daily aldosterone secretion.
In addition to the "misleading" test, he said, few people are screened at all.
Conventional guidelines suggest screening only in certain cases. That includes people who have "resistant" hypertension (the medical term for high blood pressure), which means blood pressure that remains high despite a three-medication regimen; and people with hypertension plus low potassium.
Even then among those patients, only between 2% and 3% are ever screened, said Dr William F. Young Jr., chair of endocrinology at the Mayo Clinic in Rochester, Minn.
He added, "Primary care providers don't think about primary aldosteronism or PA and do not test for it.”
Dr Young as an endocrinologist, generally sees patients only after their primary doctor refers them for specialist care.
He added, "For more t
han thirty years it has been frustrating to me to see patients who were not tested for PA when they were first diagnosed with hypertension, but rather only after they have developed irreversible, stage 4 to 5 chronic kidney disease."
Fortunately primary aldosteronism can be treated. Most often, that means healthy lifestyle changes and taking aldosterone-blocking medications called mineralocorticoid receptor antagonists which include spironolactone and eplerenone.
The research findings are based on 1,015 patients at four U.S. hospitals. Some had normal blood pressure; the rest had varying degrees of hypertension.
To screen for primary aldosterone, Dr Vaidya's team used a rigorous method: after some days on a high-sodium diet or sodium pills, patients collected their urine samples over 24 hours.
The team found that even among individuals with normal blood pressure, 11% had primary aldosteronism. That rate was 22% among individuals with resistant hypertension and those with stage 2 hypertension (blood pressure of at least 140/90 mm Hg).
It must be noted that if someone with primary aldosteronism is already on blood pressure medication, that will not suffice.
Dr Funder emphasized that one 2018 study. It found that when patients with primary aldosteronism did not have the condition sufficiently controlled with medication, their risk of heart complications and death were three times higher, versus people with hypertension only.
The researchers are advocating that current screening guidelines be changed.
Individuals with resistant hypertension should be screened (as already recommended), and that doctors should consider it for patients with more moderate hypertension.
It should be noted that the screening method used in this study is "laborious,"
Dr Vaidya said another option is to prescribe spironolactone for a period, to see if that lowers a patient's blood pressure further. The drug has been around for years, and is available as a generic.
Dr Funder was even more supportive of that tactic.
He stressed, "A three-month trial of spironolactone for patients with established hypertension is the way to go.”
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