Management of hypertension in primary aldosteronism

Area of Science:

• Endocrinology
• Nephrology
• Cardiology

Background:

• Hypertension is a major global health issue with severe cardiovascular and renal consequences.
• Primary hyperaldosteronism (PA) is the leading cause of reversible hypertension, impacting 5%-18% of hypertensive individuals.
• PA stems from bilateral adrenal hyperplasia (2/3) or unilateral aldosterone-secreting adenoma (1/3).

Purpose of the Study:

• To summarize the diagnosis, management, and outcomes of primary hyperaldosteronism.
• To emphasize the significance of early detection and treatment for preventing end-organ damage.
• To introduce the Aldosteronoma Resolution Score for predicting hypertension resolution post-adrenalectomy.

Main Methods:

• Screening via plasma aldosterone-renin ratio.
• Confirmation with noninvasive tests.
• Localization using CT imaging and adrenal vein sampling.
• Treatment involving surgical resection for adenomas and mineralocorticoid antagonists for hyperplasia.

Main Results:

• Adrenalectomy achieves 99% biochemical cure and >90% hemodynamic improvement.
• Significant reduction in antihypertensive medications is observed post-treatment.
• End-organ damage, including left ventricular hypertrophy, arterial stiffness, and proteinuria, shows marked improvement.
• The Aldosteronoma Resolution Score is a validated tool for predicting hypertension resolution.

Conclusions:

• Prompt diagnosis and treatment of PA are crucial for mitigating hypertension-related morbidity and mortality.
• Both surgical and medical interventions effectively improve hemodynamic parameters and reduce end-organ damage.
• The Aldosteronoma Resolution Score aids in clinical decision-making for patients with unilateral adenomas.