HWN Suggests

Time to revisit high blood pressure and primary aldosteronism

If you or someone you love is taking tablets for high blood pressure, now would be a good time to learn more about primary aldosteronism, a condition that has recently been declared: "the most common specifically treatable and potentially curable form of hypertension" (BMJ, 2021).

Indeed, if you were to ask your doctor about primary aldosteronism tomorrow, you might be told that it's rare, but that is not true. Recent advances in medical science have confirmed that PA is the most common cause of high blood pressure.

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Featured

 Our evolving understanding of primary aldosteronism

Primary aldosteronism is the most common endocrine cause of hypertension, and is often associated with treatment-resistant hypertension. It is characterized by autonomous aldosterone production independent of renin activity, potassium level, or volume status. Its prevalence has been debated, and studies are fraught with limitations, including reliance on tests that do not confirm the diagnosis. It has been identified as a public health issue and the urgency in identifying and treating it is heightened by its strong association with adverse kidney and cardiovascular outcomes.

Articles of Interest

Screening for primary aldosteronism: How to adjust existing antihypertensive medications to avoid diagnostic errors

An aldosterone to renin ratio (ARR) measured at least two hours after arising in the morning is the appropriate screening test. The test does not require fasting, though a fasting sample is still valid. An ARR >70, where plasma aldosterone concentration is measured by radioimmunoassay and expressed in pmol/L and direct renin concentration is measured by chemiluminescent assay and expressed in mU/L, is considered a positive screening test.

BMJ Best Practice

Primary aldosteronism is the most common specifically treatable and potentially curable form of hypertension. It accounts for at least 5% of hypertensive patients, with most patients being normokalaemic.

Practical Approaches to the Diagnosis of Primary Hyperaldosteronism

With results that can be difficult for physicians to interpret, patients being worked up for this disease benefit from multidisciplinary teams.

Primary Aldosteronism, MRAs, and Renovascular Hypertension

We demystify primary aldosteronism, MRAs (mineralocorticoid receptor antagonists), non-steroidal MRAs, and how to recognize and treat renovascular hypertension with nephrologist/hypertension expert, Dr. Matt Luther...

Primary aldosteronism: a common cause of resistant hypertension

A 2004 review of estimates of prevalence of primary aldosteronism from five continents14 concluded that primary aldosteronism is more prevalent in modern populations of patients with hypertension than previously thought.

Primary aldosteronism: current knowledge and controversies in Conn's syndrome

Primary aldosteronism has been recognized as a common cause of secondary hypertension, accounting for approximately 10% of the hypertensive population. Screening should be applied in hypertensive patients presenting with one of the following: hypokalemia, refractory hypertension, suggestive family history, or an incidentally detected adrenal mass. The most advocated screening test at present is the aldosterone-to-renin ratio, which has a high sensitivity but low specificity.

Primary Aldosteronism: JACC State-of-the-Art Review

Primary aldosteronism (PA) is a common, but frequently overlooked, cause of arterial hypertension and excess cardiovascular events, particularly atrial fibrillation. As timely diagnosis and treatment can provide a cure of hyperaldosteronism and hypertension, even when the latter is resistant to drug treatment, strategies to screen patients for PA early with a simplified diagnostic algorithm are justified.

The Unrecognized Prevalence of Primary Aldosteronism

The prevalence of primary aldosteronism is high and largely unrecognized.

Underdiagnosis of Primary Aldosteronism: A Review of Screening and Detection

A clinical condition may be missed due to its higher-than-recognized prevalence or inadequate diagnostic screening. Both factors apply to primary aldosteronism, which is woefully underdiagnosed as a cause of hypertension and end-organ damage.

Resources

Primary Aldosteronism Foundation

The Primary Aldosteronism Foundation is committed to advancing standards of care for affected patients through proper diagnosis and treatment, actionable research and inclusive collaboration.

Pulsenotes

The hallmarks of disease are hypertension and hypokalaemia - though hypokalaemia is often absent. Primary aldosteronism is increasingly being recognised as a common and under-diagnosed cause of secondary hypertension. Today prevalence is thought to be between 5-15% of patients with hypertension.

StatPearls

Primary hyperaldosteronism (PA) is an underdiagnosed cause of hypertension. The classic presentation of PA includes hypertension and hypokalemia. However, in reality, most patients will present without hyperkalemia. The two primary causes are aldosterone-producing adenomas and bilateral adrenal hyperplasia of the zona glomerulosa.

You and Your Hormones

Primary hyperaldosteronism refers to a condition in which one or both adrenal glands generate too much of a hormone called aldosterone. This causes sodium (salt) retention, leading to high blood pressure.