{"id":8626,"date":"2025-09-13T15:31:41","date_gmt":"2025-09-13T12:31:41","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8626"},"modified":"2025-09-13T15:31:41","modified_gmt":"2025-09-13T12:31:41","slug":"secondary-hypertension-primary-aldosteronism-pa","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/secondary-hypertension-primary-aldosteronism-pa\/","title":{"rendered":"Secondary Hypertension: Primary Aldosteronism (PA)"},"content":{"rendered":"<div>Secondary Hypertension: Primary Aldosteronism (PA)<\/div>\n<div><\/div>\n<div>Source : Medscape , September 08, 2025, based on ESC 2025 &amp; Current Evidence<\/div>\n<div><\/div>\n<div><span> 1. Prevalence &amp; Importance<\/span><\/div>\n<div><span> \u2022 PA is now the most common cause of secondary endocrine hypertension.<\/span><\/div>\n<div><span> \u2022 Occurs in ~10\u201320% of all hypertensives and up to 40% of resistant HTN.<\/span><\/div>\n<div><span> \u2022 Often underdiagnosed because of limited screening.<\/span><\/div>\n<div><span> 2. Pathophysiology<\/span><\/div>\n<div><span> \u2022 Autonomous aldosterone secretion \u2192 sodium retention, potassium &amp; H\u207a loss.<\/span><\/div>\n<div><span> \u2022 Results in HTN, hypokalemia, metabolic alkalosis.<\/span><\/div>\n<div><span> \u2022 CV risk is higher than essential HTN, even at same BP.<\/span><\/div>\n<div><span> 3. Clinical Clues<\/span><\/div>\n<div><span> \u2022 Resistant or severe HTN.<\/span><\/div>\n<div><span> \u2022 HTN + hypokalemia (spontaneous or diuretic-induced).<\/span><\/div>\n<div><span> \u2022 Adrenal incidentaloma.<\/span><\/div>\n<div><span> \u2022 Early-onset HTN or family history of early stroke.<\/span><\/div>\n<div><span> 4. Screening (Step 1)<\/span><\/div>\n<div><span> \u2022 Aldosterone\u2013Renin Ratio (ARR) = preferred initial test.<\/span><\/div>\n<div><span> High aldosterone + suppressed renin = suggestive.<\/span><\/div>\n<div><span> \u2022 Confirmatory testing is required in borderline biochemical results that are still in favor of abnormal.<\/span><\/div>\n<div><span> \u2022 Options: Saline infusion test, Oral sodium loading, Fludrocortisone suppression, Captopril challenge.<\/span><\/div>\n<div><span> 6. Subtype Classification (Step 3)<\/span><\/div>\n<div><span> \u2022 Imaging (CT\/MRI) for adrenal mass.\u00a0<\/span><\/div>\n<div><span> \u2022 Adrenal venous sampling (AVS): Do it in inconclusive imaging (small nodules, mild asymmetry); can skip if clear unilateral adenoma and strong biochemistry.<\/span><\/div>\n<div><span> 7. Main Etiologies<\/span><\/div>\n<div><span> \u2022 Bilateral idiopathic hyperplasia (most common).<\/span><\/div>\n<div><span> \u2022 Aldosterone-producing adenoma (Conn\u2019s).<\/span><\/div>\n<div><span> \u2022 Rare: familial forms (types 1\u20135), carcinoma, ectopic secretion.<\/span><\/div>\n<div><span> 8. Treatment<\/span><\/div>\n<div><span> \u2022 Unilateral (adenoma) \u2192 laparoscopic adrenalectomy (curative in many).<\/span><\/div>\n<div><span> \u2022 Bilateral hyperplasia \u2192 medical therapy (mineralocorticoid receptor antagonists: spironolactone, eplerenone; \u00b1 amiloride).<\/span><\/div>\n<div><span> \u2022 Familial GRA \u2192 glucocorticoids + standard therapy.<\/span><\/div>\n<div><span> 9. Prognosis<\/span><\/div>\n<div><span> \u2022 Without treatment: \u2191 risk of stroke, MI, arrhythmias, LVH, kidney damage.<\/span><\/div>\n<div><span> \u2022 Proper surgery or targeted medical therapy \u2192 markedly reduces CV risk.<\/span><\/div>\n<div><\/div>\n<div><a href=\"https:\/\/click.mail.medscape.com\/?qs=90f84957372bb8fbafaff193d64e87b4f8bc6da2993acd24fffce9efa9ed4a937666c9fcb9fe565164f2e8bd3e62a7f555bfd0bbbdb5baf3aad74d09b06d6db8\">https:\/\/click.mail.medscape.com\/?qs=90f84957372bb8fbafaff193d64e87b4f8bc6da2993acd24fffce9efa9ed4a937666c9fcb9fe565164f2e8bd3e62a7f555bfd0bbbdb5baf3aad74d09b06d6db8<\/a><\/div>\n<div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Secondary Hypertension: Primary Aldosteronism (PA) Source : Medscape , September 08, 2025, based on ESC 2025 &amp; Current Evidence 1. Prevalence &amp; Importance \u2022 PA is now the most common cause of secondary endocrine hypertension. \u2022 Occurs in ~10\u201320% of all hypertensives and up to 40% of resistant HTN. \u2022 Often underdiagnosed because of limited [&hellip;]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8626","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8626","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8626"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8626\/revisions"}],"predecessor-version":[{"id":8627,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8626\/revisions\/8627"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8626"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8626"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8626"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}