Who should be screened for primary aldosteronism? A comprehensive review of current evidence

Wei-Chieh Huang, Yen-Hung Lin, Vin-Cent Wu, Chen-Huan Chen, Saulat Siddique, Yook-Chin Chia, Jam Chin Tay, Guruprasad Sogunuru, Hao-Min Cheng, Kazuomi Kario, Wei-Chieh Huang, Yen-Hung Lin, Vin-Cent Wu, Chen-Huan Chen, Saulat Siddique, Yook-Chin Chia, Jam Chin Tay, Guruprasad Sogunuru, Hao-Min Cheng, Kazuomi Kario

Abstract

Arterial hypertension is a major risk factor for cardiovascular disease. The prevalence of primary aldosteronism (PA) ranges from 5% to 10% in the general hypertensive population and is regarded as one of the most common causes of secondary hypertension. There are two major causes of PA: bilateral adrenal hyperplasia and aldosterone-producing adenoma. The diagnosis of PA comprises screening, confirmatory testing, and subtype differentiation. The Endocrine Society Practice Guidelines for the diagnosis and treatment of PA recommends screening of patients at an increased risk of PA. These categories include patients with stage 2 and 3 hypertension, drug-resistant hypertension, hypertensive with spontaneous or diuretic-induced hypokalemia, hypertension with adrenal incidentaloma, hypertensive with a family history of early onset hypertension or cerebrovascular accident at a young age, and all hypertensive first-degree relatives of patients with PA. Recently, several studies have linked PA with obstructive sleep apnea and atrial fibrillation unexplained by structural heart defects and/or other conditions known to cause the arrhythmia, which may be partly responsible for the higher rates of cardiovascular and cerebrovascular accidents in patients with PA. The aim of this review is to discuss which patients should be screened for PA, focusing not only on well-established guidelines but also on additional groups of patients with a potentially higher prevalence of PA, as has been reported in recent research.

Keywords: aldosterone renin ratio; hypertension; primary aldosteronism; screen.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2022 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
The flow chart of diagnosis of PA in the Taiwan Expert Consensus Document for Primary aldosteronism. ARR, Aldosterone Renin Ratio; AVS, Adrenal Vein Sampling; PA, Primary Aldosteronism; MR, mineralocorticoid receptor; NP‐59, iodine‐131‐beta‐iodomethyl‐nocholesterol
FIGURE 2
FIGURE 2
Hypokalemia and primary aldosteronism in hypertensive patients (modified from Burrello study). NormoK, normokalemia; HypoK, Hypokalemia; PA, primary aldosteronism

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