AUTHOR=Nguyen Van , Tu Tian Ming , Mamauag Marlie Jane B. , Lai Jovan , Saffari Seyed Ehsan , Aw Tar Choon , Ong Lizhen , Foo Roger S. Y. , Chai Siang Chew , Fones Shaun , Zhang Meifen , Puar Troy H. 

TITLE=Primary Aldosteronism More Prevalent in Patients With Cardioembolic Stroke and Atrial Fibrillation

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.869980

DOI=10.3389/fendo.2022.869980

ISSN=1664-2392

ABSTRACT=Background 

Primary aldosteronism (PA) is the most common cause of secondary hypertension, and patients are at increased risk of atrial fibrillation (AF) and stroke. We assessed the prevalence of PA in patients with recent stroke. 

Methods 

We recruited 300 patients admitted to an acute stroke unit with diagnosis of cerebrovascular accident (haemorrhagic/ischemic) or transient ischemic attack. Three months post–stroke, plasma renin and aldosterone were measured. Patients with elevated aldosterone–renin–ratio proceeded to confirmatory saline–loading test.

Results 

Twenty six of 192 (14%) patients had elevated aldosterone–renin–ratio. Three of 14 patients who proceeded to saline–loading were confirmed with PA (post–saline aldosterone >138pmol/L). Another three patients were classified as confirmed / likely PA based on markedly elevated aldosterone–renin–ratio and clinical characteristics. The overall prevalence of PA amongst stroke patients with hypertension was 4.0% (95%CI: 0.9–7.1%). Prevalence of PA was higher amongst patients with cardioembolic stroke, 11% (95%CI: 1.3%–33%),  resistant hypertension, 11% (95%CI: 0.3%–48%), and hypertension and AF, 30% (95%CI: 6.7%–65%). If only young patients, or those with hypokalemia were screened for PA, half of our patients with PA would have not been diagnosed. Our decision tree identified that stroke patients with AF and diastolic blood pressure ≥83mmHg were most likely to have PA.

Conclusion 

We found that amongst hypertensive patients with stroke, PA was more prevalent in those with AF, or cardioembolic stroke. Screening for PA should be considered for all patients with stroke, particularly those with good functional recovery.