Front Endocrinol

High rates of primary aldosteronism persist among primary care patients with hypertension

May 15, 2025

Study details: This prospective study evaluated 1,181 Swedish primary care patients with hypertension for primary aldosteronism (PA) using the aldosterone-to-renin ratio (ARR) as the initial screening test. Confirmatory testing was performed using the IV saline suppression test (SST). Patients with confirmed PA underwent further evaluation, including adrenal venous sampling or adrenocortical-specific positron emission tomography, and were offered appropriate treatment based on lateralization results.

Results: The study identified 53 cases (mostly mild) of PA, corresponding to a prevalence of 4.5%. Initial seated ARR was higher than recumbent ARR before the first SST. At the second SST, both initial ARR and final aldosterone levels were higher than at the first SST. Among the 45 patients who accepted localizing studies, 14 had lateralized disease, and 11 underwent laparoscopic adrenalectomy. Histopathology revealed aldosterone-producing adenomas in 4 cases, with the remainder showing micro- and macronodular changes. Thirty-one patients had bilateral PA and were treated with mineralocorticoid receptor antagonists.

Clinical impact: Routine ARR-based screening in primary care can identify a significant number of PA cases, enabling targeted treatment that improves outcomes beyond standard antihypertensive therapy.

Source:

Makhnov N, et al. (2025, April 14). Front Endocrinol (Lausanne). Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertension. https://pubmed.ncbi.nlm.nih.gov/40297172/