All individuals with hypertension should be screened for primary aldosteronism (PA)
All individuals with hypertension should be screened for primary aldosteronism (PA)
🔹 Key Summary: New Guidelines on Primary Aldosteronism (PA) Screening – July 2025
1. Universal PA Screening
– All individuals with hypertension should be screened for primary aldosteronism (PA) using aldosterone and renin measurements.
– The aldosterone-to-renin ratio (ARR) is the diagnostic cornerstone.
2. Importance of Screening
– PA is a common, under-recognized cause of secondary hypertension.
– Leads to sodium retention, volume overload, and organ damage.
3. High Cardiovascular Risk in PA
– Compared to primary hypertension, PA is linked with:
* 2× risk of stroke
* 3× risk of atrial fibrillation
* 2× risk of kidney disease
* Higher risk of coronary artery disease and heart failure
4. Prevalence Data
– PA found in:
* 5.9% of general hypertensives
* 16.2% of young adults with HTN
* 28.1% of those with hypokalemia
* 42% with HTN + atrial fibrillation
* 11.3–19.1% with HTN + type 2 diabetes
5. Preferred Treatment
– MRAs (e.g., spironolactone) are first-line.
– Surgery (unilateral adrenalectomy) for lateralized PA if patient is a surgical candidate.
6. Testing Enhancements
– No need to stop all antihypertensive meds for screening in most cases.
– Include potassium levels with ARR to avoid false negatives.
7. Imaging and Further Testing
– If surgery is considered:
* Do CT scan and adrenal venous sampling.
* Consider dexamethasone suppression test for adrenal adenoma.
8. Practical Recommendations
– Prefer spironolactone over other MRAs (affordable, widely available).
– Use epithelial sodium channel blockers (such as amiloride or triamterene) only if mineralocorticoid receptor antagonists (MRAs) are not an option.
9. Global Adoption & Cost-Effectiveness
– Countries like Japan, China, and Australia already implement routine PA screening, showing long-term cost savings.
10. Expert Opinions
– Dr. Cohen: New guidelines simplify screening, remove barriers, and improve diagnosis.
– Dr. Auchus: Supports broader screening, especially in resistant hypertension, though notes age/patient selection might refine strategy.
🔗 Full article (Medscape):