Subclinical primary aldosteronism

Screening for primary aldosteronism was historically recommended in patients with moderate to severe and/or resistant hypertension. Patients with mild hypertension and normotensive subjects were therefore excluded from the screening. However, a considerable number of normotensive individuals without hypokalaemia may have subclinical forms of primary aldosteronism. In this review, we describe evidence supporting the idea that primary aldosteronism is not only confined to patients with moderate to severe and/or resistant hypertension, but also exists in patients with mild hypertension and even in those with normotension. We discuss possible aetiologies, screening and diagnostic techniques and treatment options of the normotensive form of primary aldosteronism. The natural history, adverse effects and best treatment of this disease still remain to be resolved. The long-term follow-up studies of normotensive primary aldosteronism patients who receive neither adrenal surgery nor treatment with mineralocorticoid receptor antagonists might help to solve these problems.