[Treatment refractory hypertension with atrophic kidney: attending to one and not neglecting the other]

Area of Science:

• Endocrinology
• Hypertension Research
• Clinical Biochemistry

Background:

• Primary aldosteronism is a significant cause of secondary hypertension.
• Previous estimates of its prevalence in difficult-to-treat hypertension may be underestimated.

Observation:

• The clinical presentation of primary aldosteronism is often non-specific.
• Normokalemia (normal potassium levels) is observed in a substantial proportion of patients with primary aldosteronism, challenging traditional diagnostic criteria.

Findings:

• The incidence of primary aldosteronism is higher than previously recognized in patients with resistant hypertension.
• Relying solely on hypokalemia (low potassium levels) for clinical suspicion is unreliable, as many patients are normokalemic.

Implications:

• Increased awareness and biochemical screening for primary aldosteronism are essential in patients with difficult-to-treat hypertension.
• Early and accurate diagnosis of primary aldosteronism can lead to targeted treatment and improved patient outcomes.
• Biochemical confirmation is the definitive step in diagnosing primary aldosteronism, superseding clinical suspicion alone.