Diagnosis and Treatment of Primary Aldosteronism in 2017: Did We Achieve Our Goals?

Abstract

For many decades primary aldosteronism (PA) was dismissed as a rare endocrine condition, but is nowadays widely accepted as the most frequent endocrine cause of hypertension, largely due to the widespread use of the aldosterone-to-renin ratio as a screening test. With a prevalence of 5% of hypertensive subjects in primary care and 10% of hypertensives in referral centers, screening strategies should be extended to designated risk populations, as suggested by several recent national and international guidelines [1] [2] [3]. Primary aldosteronism is highly prevalent in patients with sleep apnea, resistant hypertension (10–30%), and patients with hypokalemic hypertension (>60%). With a growing awareness of the cardiovascular and metabolic comorbidities of sustained aldosterone hypersecretion [4] [5] [6] [7], and the possibility of reversing these consequences through early detection and therapy [8], the diagnosis of PA should be timely.