Abstract
Background: Primary aldosteronism is a common treatable cause of hypertension; yet there are no prospective data on its prevalence in Albania. Therefore, this study was set out to explore the rate of a prespecified biochemical phenotype suggestive of primary aldosteronism and its clinical characteristics among consecutive hypertensive patients attending a general Cardiology outpatient clinic in Tirana.
Methods: Consecutive consenting adults referred for arterial hypertension to the Cardiology Outpatient Clinic of Catholic Hospital, Tirana, were prospectively recruited. Participants underwent a structured secondary-hypertension work-up, including standardized blood pressure assessment and biochemical evaluation after withdrawal of interfering antihypertensive medications. A positive biochemical phenotype was defined by an aldosterone-to-renin ratio >20.6 ng/mIU together with a plasma aldosterone concentration ≥15 ng/dL.
Results: From April 2021 to December 2022, 94 of 126 consecutively assessed patients completed the diagnostic work-up. Seven participants (7.4%; 3 women and 4 men) met the prespecified biochemical criteria for primary aldosteronism. A unilateral adrenal nodule was identified in five of them. The proportion meeting biochemical criteria increased across hypertension stages, from 2.9% in stage 1 to 8.5% in stage 2 and 16.7% in stage 3. A history of myocardial infarction was observed in 2 of 7 screen-positive participants and none of the 87 remaining participants.
Conclusions: In this exploratory prospective cohort study, 7.4% of hypertensive outpatients met prespecified biochemical criteria suggestive of primary aldosteronism. The observed frequency and the directional increase across hypertension-severity stages support the need of systematic screening in unselected hypertensive patients in Albania. However, given the exploratory nature of this survey, these findings are hypothesis-generating and require confirmation in larger, multicentre studies with comprehensive diagnostic and subtype assessment.