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Primary aldosteronism: Treatment of the disease, and new therapeutic approaches

John Funder1

  • 1Hudson Institute of Medical Research and Monash University, Clayton, Victoria, Australia.

Best Practice & Research. Clinical Endocrinology & Metabolism
|December 10, 2019
PubMed

Insights

Primary aldosteronism, a common cause of hypertension, is underdiagnosed. New strategies aim to improve screening, diagnosis, and treatment, potentially benefiting many patients with high blood pressure.

Area of Science:

  • Endocrinology
  • Cardiology
  • Hypertension Management

Background:

  • Primary aldosteronism accounts for 5-13% of hypertension cases.
  • Fewer than 1% of patients with primary aldosteronism are diagnosed and treated.
  • Current diagnostic and treatment protocols for primary aldosteronism are suboptimal.

Purpose of the Study:

  • To propose new therapeutic approaches for primary aldosteronism.
  • To improve the diagnostic yield and management of primary aldosteronism.
  • To enhance the early detection and treatment of hypertension secondary to primary aldosteronism.

Main Methods:

  • Routine screening for primary aldosteronism in hypertensive patients.
  • Harmonizing diagnostic cut-offs and utilizing 24-h urinary aldosterone measurements.
  • Employing a dexamethasone-enhanced seated saline suppression test for confirmation.
  • Utilizing advanced imaging and steroid profiling to reduce reliance on adrenal venous sampling.
  • Considering low-dose spironolactone as a first-line antihypertensive therapy.

Main Results:

  • The proposed methods aim to increase the diagnosis rate of primary aldosteronism.
  • Enhanced diagnostic accuracy is expected through harmonized cut-offs and improved testing.
  • New therapeutic strategies may lead to better blood pressure control and patient outcomes.

Conclusions:

  • Implementing routine screening and updated diagnostic criteria can significantly improve primary aldosteronism detection.
  • Novel imaging and biochemical tests may replace or supplement adrenal venous sampling.
  • Incorporating mineralocorticoid receptor antagonists earlier in treatment could optimize hypertension management.
Keywords:
aldosteroneharmonisationhypertensionlateralizationsodiumspironolactone

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