Is Primary Aldosteronism Still Largely Unrecognized?

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Hypertension Research

Background:

• Primary aldosteronism (PA) was initially considered rare, diagnosed only in severe hypertension with hypokalemia.
• Widespread use of the aldosterone-to-renin ratio has expanded the recognized clinical spectrum of PA.
• Epidemiological studies reveal PA prevalence of approximately 6% in general hypertensive populations and 11% in specialized centers.

Purpose of the Study:

• To highlight the discrepancy between recommended PA screening rates and actual clinical practice.
• To emphasize the under-diagnosis and under-treatment of PA.
• To underscore the significant cardiovascular risks associated with untreated PA.

Main Methods:

• Review of epidemiological studies on PA prevalence.
• Analysis of Endocrine Society guidelines for PA screening.
• Comparison of recommended screening rates with real-world clinical data.

Main Results:

• Despite guidelines recommending screening for ~50% of hypertensive patients, real-life screening rates remain significantly lower.
• PA is frequently under-diagnosed and under-treated.
• PA is associated with increased risks of cardio- and cerebrovascular mortality and morbidity.

Conclusions:

• Primary aldosteronism is a common and under-recognized cause of secondary hypertension.
• Increased awareness and improved screening practices are necessary to address the under-diagnosis of PA.
• Timely diagnosis and treatment of PA are essential for mitigating associated cardiovascular complications.