Progress in Primary Aldosteronism 2019: New Players on the Block?

Area of Science:

• Endocrinology
• Hypertension Research
• Clinical Medicine

Background:

• Primary aldosteronism (PA) is the leading cause of endocrine hypertension, characterized by excessive aldosterone secretion.
• PA affects 5.8% of primary care hypertensives, 6-12% in hypertension centers, and up to 30% with resistant hypertension.
• Despite its prevalence, PA screening is not consistently performed by healthcare providers.

Discussion:

• Low screening rates for PA are evident globally, with only 7-8% of general practitioners in Italy and Germany performing essential renin and aldosterone measurements.
• Retrospective studies show minimal PA screening (2.1%) even in high-risk populations like those with resistant hypertension.
• This lack of screening leads to a significant underdiagnosis of PA, estimated at only 1-2% in some populations.

Key Insights:

• The majority of primary aldosteronism cases remain undiagnosed due to insufficient screening practices.
• Despite established diagnostic criteria and treatments, clinical inertia prevents widespread adoption of PA screening protocols.
• There is a critical need to improve awareness and implementation of PA screening in hypertensive patients.

Outlook:

• Future efforts should focus on enhancing physician education and implementing standardized screening protocols for PA.
• Technological advancements in diagnostics may facilitate easier and more accessible PA screening.
• Increased screening rates have the potential to improve patient outcomes by enabling timely diagnosis and management of PA.