Who and How Should We Screen for Primary Aldosteronism?

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Public Health

Background:

• Primary aldosteronism (PA) is increasingly recognized as a significant contributor to hypertension, affecting at least 30% of screened patients.
• Patients with PA exhibit a substantially higher risk profile compared to essential hypertensives, even with similar blood pressure levels.
• Current screening rates for PA in hypertensive individuals remain critically low, below 1%.

Purpose of the Study:

• To highlight the underdiagnosis of primary aldosteronism (PA) in hypertensive populations.
• To propose a simple and effective screening method for PA applicable to all hypertensive patients.
• To underscore the public health implications of widespread, undiagnosed PA.

Main Methods:

• Administering spironolactone 25 mg/day for 4 weeks to hypertensive patients.
• Monitoring blood pressure response to spironolactone as a diagnostic indicator for PA.
• Comparing blood pressure changes in established and newly presenting hypertension cases.

Main Results:

• A blood pressure fall of <10 mm Hg suggests PA is unlikely, while a fall >12 mm Hg indicates probable PA.
• The proposed screening protocol is effective for both established and newly diagnosed hypertension.
• The study anticipates identifying a significant number of hypertensive patients with PA, likely predominantly bilateral disease.

Conclusions:

• A simple spironolactone challenge test can effectively screen all hypertensive patients for PA.
• The high prevalence and underdiagnosis of PA represent a major public health concern.
• Timely identification and management of PA are crucial for mitigating cardiovascular risk in hypertensive patients.