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Primary Aldosteronism: JACC State-of-the-Art Review
1Hypertension Unit, Department of Medicine, DIMED, University of Padova, Padova, Italy.
Insights
Primary aldosteronism (PA) is a common cause of hypertension and heart issues. Early screening and diagnosis are crucial for effective treatment and potential cure, especially for high-risk patients.
Area of Science:
- Endocrinology
- Cardiology
- Nephrology
Background:
- Primary aldosteronism (PA) is an underdiagnosed condition contributing to hypertension and cardiovascular events like atrial fibrillation.
- Timely diagnosis and treatment of PA can cure hyperaldosteronism and hypertension, even drug-resistant cases.
- Early screening is vital, particularly for hypertensive patients at high cardiovascular risk.
Purpose of the Study:
- To review strategies for early screening and diagnosis of primary aldosteronism.
- To discuss the role and challenges of adrenal vein sampling in subtyping PA.
- To explore advancements in drug treatment and follow-up for PA patients.
Main Methods:
- Review of current literature and diagnostic guidelines for primary aldosteronism.
- Analysis of the technical challenges and clinical utility of adrenal vein sampling.
- Discussion of emerging therapeutic strategies and follow-up protocols.
Main Results:
- Simplified diagnostic algorithms can improve early PA detection.
- Adrenal vein sampling remains the gold standard for subtyping but presents technical hurdles.
- Alternative subtyping techniques and improved drug treatments are under development.
Conclusions:
- Early identification and treatment of PA can significantly improve patient outcomes and reduce cardiovascular risk.
- Overcoming the diagnostic bottleneck, particularly with adrenal vein sampling, is essential for optimal PA management.
- Continued research into alternative diagnostic tools and therapeutic advancements is necessary.
Abstract:
Primary aldosteronism (PA) is a common, but frequently overlooked, cause of arterial hypertension and excess cardiovascular events, particularly atrial fibrillation. As timely diagnosis and treatment can provide a cure of hyperaldosteronism and hypertension, even when the latter is resistant to drug treatment, strategies to screen patients for PA early with a simplified diagnostic algorithm are justified. They can be particularly beneficial in some subgroups of hypertensive patients, as those who are at highest cardiovascular risk. However, identification of the surgically curable cases of PA and achievement of optimal results require subtyping with adrenal vein sampling, which, as it is technically challenging and currently performed only in tertiary referral centers, represents the bottleneck in the work-up of PA. Measures aimed at improving the clinical use of adrenal vein sampling and at developing alternative techniques for subtyping, alongside recommendations for drug treatment, including new development in the field, and for follow-up are discussed.
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