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Primary aldosteronism.

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Testing for Primary Aldosteronism Underutilized Following Stroke: A Multicenter Cohort Study.

Josephine McCarthy1,2,3,4, Jocelyn Widjaja1, Frank M Gao4

  • 1Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia (J.M.C., J.W., T.G.P., J.Y.).

Stroke
|November 18, 2025
PubMed
Summary

Primary aldosteronism is underdiagnosed in stroke patients despite treatment potential. Routine testing in stroke care could improve outcomes by identifying this hypertension cause.

Keywords:
blood pressurehyperaldosteronismhypertensionischemic attack, transientstroke

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Area of Science:

  • Endocrinology
  • Neurology
  • Cardiovascular Medicine

Background:

  • Primary aldosteronism is the leading endocrine cause of hypertension.
  • It significantly elevates stroke risk compared to essential hypertension.
  • Effective treatments exist, yet diagnosis rates remain low.

Purpose of the Study:

  • To determine the frequency of primary aldosteronism testing in stroke patients.
  • To assess the gap between clinical indication and actual testing for primary aldosteronism.

Main Methods:

  • A multicenter retrospective cohort study was performed.
  • Data from 400 stroke/TIA patients admitted between Jan 2019-Jan 2020 were analyzed.
  • Included data: blood pressure, medications, serum potassium, adrenal imaging.

Main Results:

  • 30% of patients had indications for testing.
  • Only 2% of eligible patients were actually tested.
  • This represents a significant missed opportunity for diagnosis.

Conclusions:

  • Primary aldosteronism is underdiagnosed in stroke patients.
  • Routine testing in stroke pathways could identify treatable hypertension.
  • Improved diagnosis may reduce recurrent cerebrovascular events.