Lj. Gates et al., Is random screening of value in detecting glucocorticoid-remediable aldosteronism within a hypertensive population?, J HUM HYPER, 15(3), 2001, pp. 173-176
Introduction: Glucocorticoid-remediable aldosteronism (GRA) is a rare inher
ited cause for hypertension associated with a significant morbidity and mor
tality at an early age. Individuals with this abnormality frequently presen
t with severe hypertension which is resistant to standard antihypertensive
therapy, a strong family history of hypertension, intracranial haemorrhage,
and sporadic hypokalaemia. However many affected individuals may appear ph
enotypically indistinguishable from normal essential hypertensives but rema
in at high risk of morbidity and mortality.
objective: To determine how effective random or targeted screening of hyper
tensive patients is for the detection of GRA.
Design: A prospective study involving the screening of 300 hypertensive pat
ients chosen at random attending the Aberdeen Hypertension Clinic and, duri
ng the same period, the targeted screening of patients with a medicaland fa
mily history suggestive of GRA.
Setting: A University hospital with a primary catchment of 500000 inhabitan
ts and a hypertension clinic population of over 8500 patients.
Results: Random screening failed to identify any GRA mutation-positive indi
viduals. Targeted screening of selected individuals revealed two index fami
lies and four further families containing 40 mutation-positive individuals.
Conclusion: Targeted screening of hypertensive individuals with a family hi
story of hypertension, cerebral haemorrhage, a history of hypertension from
an early age, resistant hypertension which has proven difficult to control
and hypokalaemia revealed two index cases and four further individuals and
30 hypertensive and 10 normotensive members of their families with GRA.