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How common is primary aldosteronism?

Gregory L Hundemer1, Gregory A Kline2, Alexander A Leung2,3

  • 1Division of Nephrology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario.

Current Opinion in Nephrology and Hypertension
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Summary

Primary aldosteronism, a common cause of secondary hypertension, is often missed. Many cases of renin-independent aldosterone excess exist beyond current diagnostic criteria, impacting more patients than previously understood.

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Area of Science:

  • Endocrinology
  • Hypertension Research
  • Clinical Medicine

Background:

  • Primary aldosteronism is the most common cause of secondary hypertension.
  • Its prevalence is higher than previously estimated, with many cases remaining undiagnosed.
  • Current screening methods fail to identify a significant number of affected individuals.

Purpose of the Study:

  • To review the current understanding of primary aldosteronism prevalence.
  • To highlight the under-recognition of this condition in broader hypertensive and normotensive populations.
  • To discuss the continuum of renin-independent aldosteronism and its implications.

Main Methods:

  • Review of recent prevalence studies on primary aldosteronism.
  • Analysis of diagnostic criteria and population heterogeneity.
  • Examination of evidence for renin-independent aldosteronism below current thresholds.

Main Results:

  • Primary aldosteronism is highly prevalent across various blood pressure categories, including mild-to-moderate hypertension and normotension.
  • Existing diagnostic thresholds may miss a substantial number of patients.
  • Renin-independent aldosteronism represents a spectrum with clinical relevance beyond established diagnostic criteria.

Conclusions:

  • Primary aldosteronism and related milder forms of renin-independent aldosteronism are widespread but significantly under-recognized.
  • A broader approach to screening and diagnosis is warranted.
  • Much of what is currently termed 'essential hypertension' may be aldosterone-mediated.