Prevention and Treatment
Central Review Committee: Stella S. Daskalopoulou, MD MSc DIC PhD (Chair); Kaberi Dasgupta, MD MSc; Kelly B. Zarnke, MD MSc; Kara Nerenberg, MD, MSc; Alexander A. Leung, MD MPH; Kevin C. Harris, MD MHSc; Kerry McBrien, MD MPH; Sonia Butalia, BSc MD MSc; Meranda Nakhla, MD MSc
Co-Chairs: Doreen M. Rabi, MD MSc, Stella S. Daskalopoulou, MD MSc DIC PhD
This information is based on the Hypertension Canada guidelines published in Nerenberg, Kara A. et al. Hypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. Can J Cardiol.
- Treatment of hyperaldosteronism and pheochromocytoma are outlined in Supplemental Tables S7 and S8, respectively.
Treatment of hyperaldosteronism and pheochromocytoma are outlined in Supplemental Tables S7 and S8, respectively.
Recommendations on diagnosis and treatment of hypertension in the setting of pheochromocytoma and hyperaldosteronism were first made in 2001. For the initial background and references, please see Part VI, recommendations A and B, which can be found in the citations – Part 1.
|Supplemental Table S7. Hyperaldosteronism|
|i. Plasma aldosterone and plasma renin activity or renin mass/concentration (see ii below for conversion factors) should be collected as follows:|
|ii. Suggested Conversion Factors:|
|A. To estimate:||B. From:||Multiply (B) by:|
|Plasma renin concentration (ng/L)||Plasma renin activity (ng/mL/hr)||0.192|
|Plasma renin activity (ng/L/sec)||Plasma renin activity (ng/mL/hr)||0.278|
|Plasma aldosterone concentration (pmol/L)||Plasma aldosterone concentration (ng/dL)||28|
|iii. Interpretation of a positive screening test is dependent upon local laboratory method for renin measurement but assumes standard reporting of aldosterone in pmol/L:|
|Renin method used||Aldosterone-to-renin ratio: higher sensitivity, lower specificity||Aldosterone-to-renin ratio: lower sensitivity, higher specificity|
|Plasma renin activity (ng/ml/h)||555||750|
|Direct renin concentration (mIU/L)||60||91|
|Direct renin concentration (ng/L)||100||144|
|iv. If one of the following criteria is met, autonomous hypersecretion of aldosterone is confirmed (interfering drugs should continue to be held, as outlined above):|
|v. Differentiating potential causes of confirmed primary aldosteronism (unilateral vs bilateral secretion):|
|vi. Treatment is informed by subtype classification (unilateral vs. bilateral secretion):|
|Supplemental Table S8. Pheochromocytoma|
|Screening AND DIAGNOSIS|
|i. To screen for pheochromocytoma|
|ii. Keep in mind that potential false positives should be considered in the setting of:|
|iii. In the presence of borderline biochemical test results or potentially false positive results, repeat testing may be performed and/or the clonidine suppression test may be used. This should be done before imaging is requested to avoid identifying potential incidentalomas.|
|iv. Imaging (e.g., CT, MRI, ± MIBG) should generally be performed only done after biochemical confirmation of disease.|
|v. Definitive treatment is with surgical resection. Preoperative planning is recommended for blood pressure control and volume expansion:|
|vi. Postoperatively, long-term follow-up is recommended with urinary or plasma metanephrines to screen for recurrence, especially in those with a genetic predisposition.|
|vii. Genetic testing should be considered for individuals <50 years of age and for all patients with multiple lesions, malignant lesions, bilateral pheochromocytomas or paragangliomas, or a family history of pheochromocytoma or paraganglioma.|