Primary Aldosteronism Can Present as Atrial Fibrillation

By Will Boggs MD

January 17, 2020

NEW YORK (Reuters Health) - Atrial fibrillation can be a presenting sign of primary aldosteronism in patients with hypertension, according to findings from the PAPPHY study.

"We believe that patients with arterial hypertension and atrial fibrillation (AF) should be screened for primary aldosteronism (PA) as early as possible, as a timely diagnosis and target treatment by surgery or mineralocorticoid-receptor antagonists can induce regression of AF and/or prevent its recurrence," Dr. Gian Paolo Rossi of Padua University Hospital, in Italy, told Reuters Health by email.

In the earlier Prevalence of Primary Aldosteronism in hYpertension (PAPY) study, patients with long-term aldosteronism had an AF risk that was significantly higher than in those whose primary aldosteronism was cured with adrenalectomy. Other studies have also suggested a higher risk of AF in patients with aldosteronism.

Dr. Rossi and colleagues in the Prospective Appraisal of the Prevalence of Primary aldosteronism in HYpertension (PAPPHY) study investigated whether AF can be a presentation of primary aldosteronism in patients with hypertension.

The team recruited 411 consecutive patients with atrial fibrillation and a clear diagnosis of arterial hypertension at three referral centers for hypertension. Among the 73 patients with hypertension and unexplained AF, 31 (42%) had a biochemical diagnosis of PA, and the remaining patients had primary (essential) hypertension.

Fifteen of the patients with PA had aldosterone-producing adenomas. Thus, 20% of the patients included in the study had a surgically curable form and 22% had a nonsurgical form of primary aldosteronism, the authors report in the Journal of Hypertension.

The rate of primary aldosteronism in this group is seven times higher than rates reported by general practitioners, four times higher than rates in patients referred to specialized hypertensive centers, and two- to three-fold higher than rates in patients with drug-resistant hypertension, Dr. Rossi and his colleagues note.

Primary aldosteronism patients had left atrial dilatation by echocardiography, but other echocardiographic measures did not differ significantly between the patients with primary aldosteronism and those with primary hypertension.

"PA is much more common than usually perceived, particularly in hypertensive patients with AF," Dr. Rossi concluded. "It often eludes diagnosis because one of its classical signs, e.g., hypokalemia, nowadays is absent in the majority of the patients."

SOURCE: Journal of Hypertension, online December 12, 2019.