Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Fast track – JSH2024 FUKUOKA
  • Published:

Differences in target organ damage between captopril challenge test-defined definitive-positive and borderline-range groups among patients with primary aldosteronism

Hypertension Research volume 48, pages 540–552 (2025)Cite this article

A Comment to this article was published on 14 November 2024

Abstract

The new Japanese guidelines for primary aldosteronism introduce a category in the judgment of functional confirmatory tests that is called the “borderline range,” which is rare in the other international guidelines. The clinical characteristics of this borderline group are not yet understood. To investigate whether this borderline group has any significant differences in terms of target organ damage, we used data from a Japanese nationwide registry (JPAS-II) of individuals with primary aldosteronism or essential hypertension to compare the borderline group with the definitive-positive group and the negative group. We analyzed the cases of 1785 patients based on their captopril-challenge test results. Since the JPAS-II database contains plasma aldosterone concentration values obtained based on both radioimmunoassay (n = 1555) and chemiluminescent enzyme immunoassay (n = 230) principles, we converted these values to their equivalents as if measured by chemiluminescent enzyme immunoassay and conducted all analyses under the simulated condition. Multicovariate-adjusted models revealed significant prevalance odds ratios for chronic kidney disease (2.01, 95% confidence interval: 1.13 to 3.61), electrocardiographic abnormalities (1.66, 95% confidence interval: 1.16 to 2.37). No significant difference was observed between the borderline and negative groups in these assessments (odds ratio [95% confidence interval] for chronic kidney disease: 0.73 [0.26 to 2.02] and electrocardiographic abnormalities: 1.01 [0.60 to 1.70]). We confirmed that the prevalence of target organ damage increases linearly as the aldosterone-to-renin ratio rises following the captopril challenge test. These results provide material to consider regarding the significance of the provisionally established borderline group.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Conn JW, Knopf RF, Nesbit RM. Clinical characteristics of primary aldosteronism from an analysis of 145 cases. Am J Surg. 1964;107:159–72.

    CAS  PubMed  Google Scholar 

  2. Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol. 2017;69:1811–20.

    PubMed  Google Scholar 

  3. Naruse M, Katabami T, Shibata H, Sone M, Takahashi K, Tanabe A, et al. Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021. Endocr J. 2022;69:327–59.

    PubMed  Google Scholar 

  4. Brown NJ. Contribution of aldosterone to cardiovascular and renal inflammation and fibrosis. Nat Rev Nephrol. 2013;9:459–69.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Bianchi S, Batini V, Bigazzi R. The renal effects of mineralocorticoid receptor antagonists. Int J Cardiol. 2015;200:20–24.

    PubMed  Google Scholar 

  6. Manosroi W, Atthakomol P, Wattanawitawas P, Buranapin S. Differences in glycemic abnormalities between primary aldosteronism and essential hypertension: a systematic review and meta-analysis. Front Endocrinol. 2022;13:870047.

  7. Briet M, Schiffrin EL. The role of aldosterone in the metabolic syndrome. Curr Hypertens Rep. 2011;13:163–72.

    CAS  PubMed  Google Scholar 

  8. Haze T, Hatakeyama M, Komiya S, Kawano R, Ohki Y, Suzuki S, et al. Association of the ratio of visceral-to-subcutaneous fat volume with renal function among patients with primary aldosteronism. Hypertens Res. 2021;44:1341–51.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Haze T, Ozawa M, Kawano R, Haruna A, Ohki Y, Suzuki S, et al. Effect of the interaction between the visceral-to-subcutaneous fat ratio and aldosterone on cardiac function in patients with primary aldosteronism. Hypertens Res. 2023;46:1132–44.

    CAS  PubMed  Google Scholar 

  10. Chen SY, Chen JY, Huang WC, Puar THK, Chin Kek P, Chueh JS, et al. Cardiovascular outcomes and all-cause mortality in primary aldosteronism after adrenalectomy or mineralocorticoid receptor antagonist treatment: a meta-analysis. Eur J Endocrinol. 2022;187:S47–S58.

    CAS  PubMed  Google Scholar 

  11. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6:51–59.

    PubMed  Google Scholar 

  12. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Renal outcomes in medically and surgically treated primary aldosteronism. Hypertension. 2018;72:658–66.

    CAS  PubMed  Google Scholar 

  13. Haze T, Tamura K. Possible relationship between primary aldosteronism and small vessel disease. Hypertens Res. 2023;47:677–78.

    PubMed  Google Scholar 

  14. Qian N, Xu J, Wang Y. Stroke risks in primary aldosteronism with different treatments: a systematic review and meta-analysis. J Cardiovasc Dev Dis. 2022;9:300.

  15. Wu V-C, Wang S-M, Huang K-H, Tsai YC, Chan C-K, Yang S-Y, et al. Long-term mortality and cardiovascular events in patients with unilateral primary aldosteronism after targeted treatments. Eur J Endocrinol. 2021;186:195–205.

    PubMed  Google Scholar 

  16. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:1889–916.

    CAS  PubMed  Google Scholar 

  17. Amar L, Baguet JP, Bardet S, Chaffanjon P, Chamontin B, Douillard C, et al. SFE/SFHTA/AFCE primary aldosteronism consensus: introduction and handbook. Ann Endocrinol. 2016;77:179–86.

    Google Scholar 

  18. Nishikawa T, Omura M, Satoh F, Shibata H, Takahashi K, Tamura N, et al. Guidelines for the diagnosis and treatment of primary aldosteronism–the Japan Endocrine Society 2009. Endocr J. 2011;58:711–21.

    CAS  PubMed  Google Scholar 

  19. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481.

    PubMed  Google Scholar 

  20. Kobayashi H, Nakamura Y, Abe M, Tanabe A, Sone M, Katabami T, et al. Impact of a change to a novel chemiluminescent immunoassay for measuring plasma aldosterone on the diagnosis of primary aldosteronism. Endocr J. 2023;70:489–500.

    CAS  PubMed  Google Scholar 

  21. Kobayashi H, Nakamura Y, Abe M, Nakamura T, Nozato Y, Izawa S, et al. Prevalence of unilateral hyperaldosteronism in primary aldosteronism: impact of a novel chemiluminescent immunoassay for measuring plasma aldosterone in Japan. Hypertens Res. 2024; https://doi.org/10.1038/s41440-024-01786-5.

  22. Ohno Y, Sone M, Inagaki N, Yamasaki T, Ogawa O, Takeda Y, et al. Prevalence of cardiovascular disease and its risk factors in primary aldosteronism: a multicenter study in Japan. Hypertension. 2018;71:530–37.

    CAS  PubMed  Google Scholar 

  23. Haze T, Yano Y, Hatano Y, Tamura K, Kurihara I, Kobayashi H, et al. Association of achieved blood pressure after treatment for primary aldosteronism with long-term kidney function. J Hum Hypertens. 2022;36:904–10.

    CAS  PubMed  Google Scholar 

  24. Kobayashi Y, Haze T, Yano Y, Tamura K, Kurihara I, Ichijo T, et al. Associations between changes in plasma renin activity and aldosterone concentrations and changes in kidney function after treatment for primary aldosteronism. Kidney Int Rep. 2020;5:1291–97.

    PubMed  PubMed Central  Google Scholar 

  25. Haze T, Hirawa N, Yano Y, Tamura K, Kurihara I, Kobayashi H, et al. Association of aldosterone and blood pressure with the risk for cardiovascular events after treatments in primary aldosteronism. Atherosclerosis. 2021;324:84–90.

    CAS  PubMed  Google Scholar 

  26. Mulatero P, Paglieri C, Morello F, Chiandussi L. Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism. Hypertension. 2002; 40:897–902.

  27. Hua KF, Wu YH, Zhang ST. Clinical diagnostic value of liquid chromatography-tandem mass spectrometry method for primary aldosteronism in patients with hypertension: a systematic review and meta-analysis. Front Endocrinol. 2022;13:1032070.

    Google Scholar 

  28. Levin A, Stevens PE, Bilous RW, Coresh J, De Francisco AL, De Jong PE, et al. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.

    Google Scholar 

  29. White SL, Yu R, Craig JC, Polkinghorne KR, Atkins RC, Chadban SJ. Diagnostic accuracy of urine dipsticks for detection of albuminuria in the general community. Am J Kidney Dis. 2011;58:19–28.

    PubMed  Google Scholar 

  30. Irie F, Iso H, Sairenchi T, Fukasawa N, Yamagishi K, Ikehara S, et al. The relationships of proteinuria, serum creatinine, glomerular filtration rate with cardiovascular disease mortality in Japanese general population. Kidney Int. 2006;69:1264–71.

    CAS  PubMed  Google Scholar 

  31. Williams TA, Lenders JWM, Mulatero P, Burrello J, Rottenkolber M, Adolf C, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 2017;5:689–99.

    PubMed  PubMed Central  Google Scholar 

  32. White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011;30:377–99.

    PubMed  Google Scholar 

  33. Guo Z, Poglitsch M, McWhinney BC, Ungerer JPJ, Ahmed AH, Gordon RD, et al. Aldosterone LC-MS/MS assay-specific threshold values in screening and confirmatory testing for primary aldosteronism. J Clin Endocrinol Metab. 2018;103:3965–73.

    PubMed  Google Scholar 

  34. Vaidya A, Mulatero P, Baudrand R, Adler GK. The expanding spectrum of primary aldosteronism: implications for diagnosis, pathogenesis, and treatment. Endocr Rev. 2018;39:1057–88.

    PubMed  PubMed Central  Google Scholar 

  35. Lim PO, Struthers AD, MacDonald TM. The neurohormonal natural history of essential hypertension: towards primary or tertiary aldosteronism? J Hypertens. 2002;20:11–15.

    CAS  PubMed  Google Scholar 

  36. Neves MF, Schiffrin EL. Aldosterone: a risk factor for vascular disease. Curr Hypertens Rep. 2003;5:59–65.

    Google Scholar 

  37. Tomaschitz A, Pilz S, Ritz E, Meinitzer A, Boehm BO, März W. Plasma aldosterone levels are associated with increased cardiovascular mortality: the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. Eur Heart J. 2010;31:1237–47.

    CAS  PubMed  Google Scholar 

  38. Nanba K, Tsuiki M, Nakao K, Nanba A, Usui T, Tagami T, et al. A subtype prediction score for primary aldosteronism. J Hum Hypertens. 2014;28:716–20.

    CAS  PubMed  Google Scholar 

  39. Wada N, Miyoshi A, Usubuchi H, Terae S, Shibayama Y, Takahashi B, et al. Prediction of unilateral hyperaldosteronism on adrenal vein sampling using captopril challenge test in patients with primary aldosteronism. Endocr J. 2021;68:45–51.

    CAS  PubMed  Google Scholar 

  40. Kobayashi H, Haketa A, Ueno T, Ikeda Y, Hatanaka Y, Tanaka S, et al. Scoring system for the diagnosis of bilateral primary aldosteronism in the outpatient setting before adrenal venous sampling. Clin Endocrinol. 2017;86:467–72.

    CAS  Google Scholar 

  41. Weigel M, Riester A, Hanslik G, Lang K, Willenberg HS, Endres S, et al. Post-saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism. Eur J Endocrinol. 2015;172:443–50.

    CAS  PubMed  Google Scholar 

  42. Wu C-H, Wu V, Yang Y-W, Lin Y-H, Yang S-Y, Lin P-C, et al. Plasma aldosterone after seated saline infusion test outperforms captopril test at predicting clinical outcomes after adrenalectomy for primary aldosteronism. Am J Hypertens. 2019;32:1066–74.

    CAS  PubMed  Google Scholar 

  43. Xiang Q, Wang W, Chen T, Yu K, Li Q, Zhang T, et al. The value of the post-captopril aldosterone/renin ratio for the diagnosis of primary aldosteronism and the influential factors: a meta-analysis. J Renin Angiotensin Aldosterone Syst. 2020;21:1470320320972032.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024;105:s117–s314.

  45. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e563–e95.

    PubMed  PubMed Central  Google Scholar 

  46. Ha J, Park JH, Kim KJ, Kim JH, Jung KY, Lee J, et al. 2023 Korean Endocrine Society consensus guidelines for the diagnosis and management of primary aldosteronism. Endocrinol Metab. 2023;38:597–618.

    CAS  Google Scholar 

Download references

Acknowledgements

We express our gratitude to all JPAS-II investigators.

JPAS II study group

Masakatsu Sone15, Kenichi Yokota15, Takuyuki Katabami17, Mitsuhide Naruse16, Keiichiro Nakamae16, Toshifumi Nakamura11, Akiyo Tanabe18, Daisuke Taura6, Yoshihiro Ogawa19, Kouichi Yamamoto20, Takashi Yoneda21, Mitsuhiro Kometani21, Tetsuya Yamada14, Masanori Murakami14, Katsutoshi Takahashi22, Hiroki Kobayashi10, Takamasa Ichijo7, Norio Wada13, Kohei Kamemura5, Yuichi Fujii23, Yuichiro Yoshikawa24, Shintaro Okamura25, Shigeatsu Hashimoto26, Minemori Watanabe9, Shoichiro Izawa12, Mika Tsuiki4, Hiromasa Goto27, Miki Kakutani28, Kouichi Tamura1, Nobuhito Hirawa3, Takehiro Kato29, Yutaka Takahashi8, Ryuji Okamoto30, Kazutoshi Miyashita31, Kihei Yoneyama32, Michio Otsuki33

Funding

JPAS and JRAS were supported by the research grant from the Japan Agency for Medical Research and Development (AMED) under Grant number JP17ek0109122 and JP20ek0109352. JPAS-II was partly supported by a Grant-in-Aid from the Ministry of Health, Labour, and Welfare, Japan (No. 23FC0201 for research on intractable adrenal disorders).

Author information

Author notes

  1. These authors contributed equally: Naoki Fujiwara, Tatsuya Haze.

Authors and Affiliations

  1. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Naoki Fujiwara, Tatsuya Haze, Hiromichi Wakui, Kouichi Tamura & Kouichi Tamura

  2. YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan

    Tatsuya Haze

  3. Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan

    Tatsuya Haze, Kouichi Tamura & Nobuhito Hirawa

  4. Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Mika Tsuiki

  5. Department of Cardiology, Shinko Hospital, Kobe, Japan

    Kohei Kamemura

  6. Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Daisuke Taura

  7. Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan

    Takamasa Ichijo

  8. Department of Diabetes and Endocrinology, Nara Medical University, Nara, Japan

    Yutaka Takahashi

  9. Department of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki, Japan

    Minemori Watanabe

  10. Division of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan

    Hiroki Kobayashi

  11. Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan

    Toshifumi Nakamura

  12. Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine, Yonago, Japan

    Shoichiro Izawa

  13. Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan

    Norio Wada

  14. Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Tetsuya Yamada & Masanori Murakami

  15. Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan

    Kenichi Yokota & Masakatsu Sone

  16. Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan

    Mitsuhide Naruse & Keiichiro Nakamae

  17. Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University Yokohama Seibu Hospital, Yokohama, Japan

    Takuyuki Katabami

  18. Division of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan

    Akiyo Tanabe

  19. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Yoshihiro Ogawa

  20. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan

    Kouichi Yamamoto

  21. Department of Health Promotion and Medicine of the Future, Kanazawa University Graduate School of Medicine, Kanazawa, Japan

    Takashi Yoneda & Mitsuhiro Kometani

  22. Division of Metabolism, Showa General Hospital, Kodaira, Japan

    Katsutoshi Takahashi

  23. Fujii Junkanki Naika Clinic, Hiroshima, Japan

    Yuichi Fujii

  24. Department of Endocrinology and Diabetes Mellitus, Misato Kenwa Hospital, Misato, Japan

    Yuichiro Yoshikawa

  25. Department of Endocrinology, Tenri Hospital, Tenri, Japan

    Shintaro Okamura

  26. Division of Nephrology, Hypertension, Endocrinology, and Diabetology/Metabolism, Fukushima Medical University Hospital, Fukushima, Japan

    Shigeatsu Hashimoto

  27. Department of Metabolism & Endocrinology, Juntendo University Graduate School, Tokyo, Japan

    Hiromasa Goto

  28. Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan

    Miki Kakutani

  29. Department of Diabetes, Endocrinology and Metabolism, Gifu University Graduate School of Medicine, Gifu, Japan

    Takehiro Kato

  30. Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan

    Ryuji Okamoto

  31. Department of Internal Medicine, International University of Health and Welfare Mita Hospital, Tokyo, Japan

    Kazutoshi Miyashita

  32. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan

    Kihei Yoneyama

  33. Department of Endocrinology, Tokyo Women’s Medical University, Tokyo, Japan

    Michio Otsuki

Authors
  1. Naoki Fujiwara
    View author publications

    Search author on:PubMed Google Scholar

  2. Tatsuya Haze
    View author publications

    Search author on:PubMed Google Scholar

  3. Hiromichi Wakui
    View author publications

    Search author on:PubMed Google Scholar

  4. Kouichi Tamura
    View author publications

    Search author on:PubMed Google Scholar

  5. Mika Tsuiki
    View author publications

    Search author on:PubMed Google Scholar

  6. Kohei Kamemura
    View author publications

    Search author on:PubMed Google Scholar

  7. Daisuke Taura
    View author publications

    Search author on:PubMed Google Scholar

  8. Takamasa Ichijo
    View author publications

    Search author on:PubMed Google Scholar

  9. Yutaka Takahashi
    View author publications

    Search author on:PubMed Google Scholar

  10. Minemori Watanabe
    View author publications

    Search author on:PubMed Google Scholar

  11. Hiroki Kobayashi
    View author publications

    Search author on:PubMed Google Scholar

  12. Toshifumi Nakamura
    View author publications

    Search author on:PubMed Google Scholar

  13. Shoichiro Izawa
    View author publications

    Search author on:PubMed Google Scholar

  14. Norio Wada
    View author publications

    Search author on:PubMed Google Scholar

  15. Tetsuya Yamada
    View author publications

    Search author on:PubMed Google Scholar

  16. Kenichi Yokota
    View author publications

    Search author on:PubMed Google Scholar

  17. Mitsuhide Naruse
    View author publications

    Search author on:PubMed Google Scholar

  18. Masakatsu Sone
    View author publications

    Search author on:PubMed Google Scholar

Consortia

JPAS II study group

  • Masakatsu Sone
  • , Kenichi Yokota
  • , Takuyuki Katabami
  • , Mitsuhide Naruse
  • , Keiichiro Nakamae
  • , Toshifumi Nakamura
  • , Akiyo Tanabe
  • , Daisuke Taura
  • , Yoshihiro Ogawa
  • , Kouichi Yamamoto
  • , Takashi Yoneda
  • , Mitsuhiro Kometani
  • , Tetsuya Yamada
  • , Masanori Murakami
  • , Katsutoshi Takahashi
  • , Hiroki Kobayashi
  • , Takamasa Ichijo
  • , Norio Wada
  • , Kohei Kamemura
  • , Yuichi Fujii
  • , Yuichiro Yoshikawa
  • , Shintaro Okamura
  • , Shigeatsu Hashimoto
  • , Minemori Watanabe
  • , Shoichiro Izawa
  • , Mika Tsuiki
  • , Hiromasa Goto
  • , Miki Kakutani
  • , Kouichi Tamura
  • , Nobuhito Hirawa
  • , Takehiro Kato
  • , Yutaka Takahashi
  • , Ryuji Okamoto
  • , Kazutoshi Miyashita
  • , Kihei Yoneyama
  •  & Michio Otsuki

Corresponding author

Correspondence to Tatsuya Haze.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujiwara, N., Haze, T., Wakui, H. et al. Differences in target organ damage between captopril challenge test-defined definitive-positive and borderline-range groups among patients with primary aldosteronism. Hypertens Res 48, 540–552 (2025). https://doi.org/10.1038/s41440-024-01943-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-024-01943-w

Keywords

Search

Advanced search

Quick links