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Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline.
Gail K Adler1, Michael Stowasser2, Ricardo R Correa3
1Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
The Journal of Clinical Endocrinology and Metabolism
|July 14, 2025
Summary
Primary aldosteronism (PA) screening is recommended for all hypertension patients. Updated guidelines suggest PA-specific medical or surgical therapy to improve blood pressure control and reduce cardiovascular risks.
Area of Science:
- Endocrinology
- Cardiology
- Hypertension Management
Background:
- Primary aldosteronism (PA) is a common cause of hypertension due to excessive aldosterone.
- PA increases cardiovascular complication risk compared to primary hypertension.
- PA is significantly underdiagnosed and undertreated despite effective treatments.
Purpose of the Study:
- To provide updated guidelines for practical identification and management of PA.
- To improve PA diagnosis rates and encourage targeted treatment strategies.
Main Methods:
- A multidisciplinary Guideline Development Panel (GDP) utilized the GRADE approach.
- Systematic reviews informed 10 key questions on PA diagnosis and treatment.
- The GRADE Evidence to Decision (EtD) framework considered clinical and economic factors.
Main Results:
- Screen all hypertension patients for PA using aldosterone, renin, and aldosterone-to-renin ratio.
- Initiate PA-specific medical or surgical therapy based on screening and testing results.
- Recommend mineralocorticoid receptor antagonists (MRAs), particularly spironolactone, for medical treatment.
Conclusions:
- The guidelines offer a practical framework for PA diagnosis and treatment.
- The aim is to enhance PA identification and improve patient outcomes through targeted therapy.
- Knowledge gaps in PA diagnosis and management are identified.
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