Primary aldosteronism: evidence against a second epidemic

Area of Science:

• Endocrinology
• Hypertension Research
• Clinical Diagnostics

Background:

• Primary aldosteronism is commonly considered the leading cause of secondary hypertension.
• Current diagnostic practices rely heavily on the aldosterone-to-renin ratio (ARR) screening test.

Purpose of the Study:

• To critically evaluate the prevalence estimates of primary aldosteronism.
• To challenge the routine use of the ARR screening test.
• To propose a revised diagnostic and therapeutic strategy for hypertension.

Main Methods:

• Review of existing literature and diagnostic data.
• Analysis of the impact of referral bias on prevalence studies.
• Evaluation of the accuracy and limitations of the ARR test.

Main Results:

• Evidence suggests referral bias significantly inflates primary aldosteronism prevalence estimates.
• The ARR test is frequently inaccurate, leading to further misleading investigations.
• Overdiagnosis can result in unnecessary and potentially harmful interventions.

Conclusions:

• The widely accepted prevalence of primary aldosteronism is likely overestimated.
• A more conservative diagnostic approach with limited testing is warranted.
• Mineralocorticoid receptor antagonists should be considered for broader hypertension treatment.