Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Primary aldosteronism in elderly, old, and very old patients

Journal of Human Hypertension volume 34, pages 807–813 (2020)Cite this article

Subjects

Abstract

Primary aldosteronism (PA) is common, but usually overlooked in the elderly, old, and very old patients in whom the already high absolute risk of cardiovascular events, particularly atrial fibrillation, can be further increased by PA. Although in the last two decades there has been an explosion of studies devoted to diagnosis, subtyping, and treatment of PA, only relatively scant investigation has addressed these topics in patients older than 65 years of age. This narrative review fills a gap of information on the challenges of diagnosing and managing the PA patients who are 65 years old and older with particular attention to the benefit/risk ratio of pursuing the diagnosis in this cohort, which is markedly expanding owing to ageing of the population worldwide.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hung C-S, Sung S-H, Liao C-W, Pan C-T, Chang C-C, Chen Z-W, et al. Aldosterone induces vascular damage—a wave reflection analysis study. Hypertension. 2019;74:623–9.

    Article  CAS  Google Scholar 

  2. Rossi GP, Maiolino G. Excess arterial damage in hyperaldosteronism: further evidence from pressure wave analysis. Hypertension. 2019;74:502–4.

    Article  CAS  Google Scholar 

  3. Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol. 2017;69:1811–20.

    Article  Google Scholar 

  4. Käyser SC, Dekkers T, Groenewoud HJ, Van Der Wilt GJ, Carel Bakx J, Van Der Wel MC, et al. Study heterogeneity and estimation of prevalence of primary aldosteronism: a systematic review and meta-regression analysis. J Clin Endocrinol Metab. 2016;101:2826–35.

    Article  Google Scholar 

  5. Baudrand R, Guarda FJ, Fardella C, Hundemer G, Brown J, Williams G, et al. Continuum of renin-independent aldosteronism in normotension. Hypertension. 2017;69:950–6.

    Article  CAS  Google Scholar 

  6. Funder JWW, Carey RMM, Mantero F, Murad MHH, Reincke M, Shibata H, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:1889–916.

    Article  CAS  Google Scholar 

  7. Rossi GP. Primary aldosteronism: JACC state-of-the-art review. J Am Coll Cardiol. 2019;74:2799–811.

    Article  CAS  Google Scholar 

  8. Hiramatsu K, Yamada T, Yukimura Y, Komiya I, Ichikawa K, Ishihara M, et al. A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients. Arch Intern Med. 1981;141:1589–93.

    Article  CAS  Google Scholar 

  9. Rossi GP, Seccia TM, Palumbo G, Belfiore A, Bernini G, for the Prevalence in hYpertension (PAPY) Study Investigators, et al. Within-patient reproducibility of the aldosterone:renin ratio in primary aldosteronism. Hypertension. 2010;55:83–9.

    Article  CAS  Google Scholar 

  10. Maiolino G, Rossitto G, Bisogni V, Cesari M, Seccia TM, Plebani M, et al. Quantitative value of aldosterone-renin ratio for detection of aldosterone-producing adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) study. J Am Heart Assoc. 2017;6:e005574.

    Article  Google Scholar 

  11. Rossi GP, Ceolotto G, Rossitto G, Seccia TM, Maiolino G, Berton C, et al. Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertension. Clin Chem Lab Med. 2016;54:1441–50.

    Article  CAS  Google Scholar 

  12. Rossi GP, Bisogni V. An app for the diagnosis of primary aldosteronism. Am J Hypertens. 2016;29:660–1.

    Article  Google Scholar 

  13. Nanba K, Vaidya A, Williams GH, Zheng I, Else T, Rainey WE. Age-related autonomous aldosteronism. Circulation. 2017;136:347–55.

    Article  CAS  Google Scholar 

  14. Nakama C, Kamide K, Kawai T, Hongyo K, Ito N, Onishi M, et al. The influence of aging on the diagnosis of primary aldosteronism. Hypertens Res. 2014;37:1062–7.

    Article  CAS  Google Scholar 

  15. Ma L, Song Y, Mei M, He W, Hu J, Cheng Q, et al. Age-related cutoffs of plasma aldosterone/renin concentration for primary aldosteronism screening. Int J Endocrinol. 2018;2018:article ID:8647026.

  16. Luo Q, Li NF, Yao XG, Zhang DL, Abulikemu SFY, Chang GJ, et al. Potential effects of age on screening for primary aldosteronism. J Hum Hypertens. 2016;30:53–61.

    Article  Google Scholar 

  17. Hannemann A, Friedrich N, Lüdemann J, Völzke H, Rettig R, Peters J, et al. Reference intervals for aldosterone, renin, and the aldosterone-to-renin ratio in the population-based study of health in pomerania (SHIP−1). Horm Metab Res. 2010;42:392–9.

    Article  CAS  Google Scholar 

  18. Gan W, Lin W, Ouyang J, Li Y, Chen D, Yao Z, et al. High efficiency of the aldosterone-to-renin ratio in precisely detecting primary aldosteronism. J Hum Hypertens. 2019;33:57–61.

    Article  CAS  Google Scholar 

  19. Staessen J, Amery AFR. Isolated systolic hypertension in the elderly. J Hypertens. 1990;8:393–405.

    Article  CAS  Google Scholar 

  20. Strauch B, Petrak O, Zelinka T, Wichterle D, Holaj R, Kasalicky M, et al. Adrenalectomy improves arterial stiffness in primary aldosteronism. Am J Hypertens. 2008;21:1086–92.

    Article  Google Scholar 

  21. Franklin SS, Gustin W 4th, Wong ND, Larson MG, Weber MA, Kannel WB, Levy D. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1997;96:308–15.

    Article  CAS  Google Scholar 

  22. Rossi GP, Seccia TM, Pessina AC. A diagnostic algorithm–the holy grail of primary aldosteronism. Nat Rev Endocrinol. 2011;7:697–9.

    Article  Google Scholar 

  23. Seccia TM, Fassina A, Nussdorfer GG, Pessina AC, Rossi GP. Aldosterone-producing adrenocortical carcinoma: an unusual cause of Conn’s syndrome with an ominous clinical course. Endocr Relat Cancer. 2005;12:149–59.

    Article  Google Scholar 

  24. Zhu L, Zhang Y, Zhang H, Zhou W, Shen Z, Zheng F, et al. Comparison between adrenal venous sampling and computed tomography in the diagnosis of primary aldosteronism and in the guidance of adrenalectomy. Medicine. 2016;95:1–6.

    Article  Google Scholar 

  25. Takeda M, Yamamoto K, Akasaka H, Rakugi H, Naruse M, Takeda Y, et al. Clinical characteristics and postoperative outcomes of primary aldosteronism in the elderly. J Clin Endocrinol Metab. 2018;103:3620–9.

    Article  Google Scholar 

  26. Rossi GP, Mulatero P, Satoh F. 10 good reasons why adrenal vein sampling is the preferred method for referring primary aldosteronism patients for adrenalectomy. J Hypertens. 2019;37:603–11.

    Article  CAS  Google Scholar 

  27. Rossi GP, Barisa M, Allolio B, Auchus RJ, Amar L, Cohen D, et al. The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab. 2012;97:1606–14.

    Article  CAS  Google Scholar 

  28. Akasaka H, Yamamoto K, Rakugi H, Nagasawa M, Nakamaru R, Ichijo T, et al. Sex difference in the association between subtype distribution and age at diagnosis in patients with primary aldosteronism. Hypertension 2019;74:368–74.

    Article  CAS  Google Scholar 

  29. Iacobone M, Mantero F, Basso SM, Lumachi F, Favia G. Results and long-term follow-up after unilateral adrenalectomy for ACTH-independent hypercortisolism in a series of fifty patients. J Endocrinol Investig. 2005;28:327–32.

    Article  CAS  Google Scholar 

  30. Vriens MR, WMCM Vorselaars, Nell S, Postma EL, Zarnegar R, Drake FT, et al. Clinical outcomes after unilateral adrenalectomy for primary aldosteronism. JAMA Surg. 2019;154:e185842.

    Article  Google Scholar 

  31. Rossi GP, Rossitto G, Amar L, Azizi M, Riester A, Reincke M, et al. The clinical outcomes of 1625 patients with primary aldosteronism subtyped with adrenal vein sampling. Hypertension. 2019;74:800–8.

    Article  CAS  Google Scholar 

  32. Liang KW, Jahangiri Y, Tsao TF, Tyan YS, Huang HH. Effectiveness of thermal ablation for aldosterone-producing adrenal adenoma: a systematic review and meta-analysis of clinical and biochemical parameters. J Vasc Interv Radiol. 2019;30:1335–42.e1.

    Article  Google Scholar 

  33. Hokotate H, Inoue H, Baba Y, Tsuchimochi S, Nakajo M. Aldosteronomas: experience with superselective adrenal arterial embolization in 33 cases. Radiology. 2003;227:401–6.

    Article  Google Scholar 

  34. Wada N, Shibayama Y, Umakoshi H, Ichijo T, Fujii Y, Kamemura K, et al. Hyperkalemia in both surgically and medically treated patients with primary aldosteronism. J Hum Hypertens. 2017;31:627–32.

    Article  CAS  Google Scholar 

  35. Tahir A, McLaughlin K, Kline G. Severe hyperkalemia following adrenalectomy for aldosteronoma: prediction, pathogenesis and approach to clinical management- a case series. BMC Endocr Disord. 2016;16:43.

    Article  CAS  Google Scholar 

  36. Hundemer GL, Baudrand R, Brown JM, Curhan G, Williams GH, Vaidya A. Renin phenotypes characterize vascular disease, autonomous aldosteronism, and mineralocorticoid receptor activity. J Clin Endocrinol Metab. 2017;102:1835–43.

    Article  Google Scholar 

  37. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6:51–9.

    Article  Google Scholar 

  38. Capelli I, Gasperoni L, Ruggeri M, Donati G, Baraldi O, Sorrenti G, et al. New mineralocorticoid receptor antagonists: update on their use in chronic kidney disease and heart failure. J Nephrol. 2010;33:37–48.

    Article  Google Scholar 

  39. Lim PO, Jung RT, MacDonald TM. Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow-up study. Br J Clin Pharmacol. 1999;48:756–60.

    Article  CAS  Google Scholar 

  40. Dietz JD, Du S, Bolten CW, Payne MA, Xia C, Blinn JR, et al. A number of marketed dihydropyridine calcium channel blockers have mineralocorticoid receptor antagonist activity. Hypertension. 2008;51:742–8.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

GPR research was mostly supported by research grants from the EU COST-ADMIRE BM1301 and ENSAT-HT 633983, FORICA (The Foundation for advanced Research In Hypertension and Cardiovascular diseases) and the Società Italiana dell’Ipertensione Arteriosa and The University of Padua.

Author information

Authors and Affiliations

  1. Clinica dell’Ipertensione Arteriosa, Department of Medicine—DIMED, University of Padua, Padua, Italy

    Maurizio Cesari, Teresa Maria Seccia, Giuseppe Maiolino & Gian Paolo Rossi

Authors
  1. Maurizio Cesari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Teresa Maria Seccia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giuseppe Maiolino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gian Paolo Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gian Paolo Rossi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cesari, M., Seccia, T.M., Maiolino, G. et al. Primary aldosteronism in elderly, old, and very old patients. J Hum Hypertens 34, 807–813 (2020). https://doi.org/10.1038/s41371-020-00395-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-020-00395-2

Search

Advanced search

Quick links