Prevalence of primary aldosteronism and screening indications

Primary aldosteronism (PA) is a common yet underrecognized cause of secondary hypertension. Once identified as Conn's syndrome with hypokalemia and adrenal tumors, PA now includes broader forms with inappropriate aldosterone secretion and low renin. Despite its link to cardiovascular risk, under 15 percent of eligible patients are screened, leading to underestimated prevalence and missed treatment chances. Main Section: Improved assays and awareness reveal PA is more frequent than believed, often without hypokalemia and even in normotensive patients. Meta-analyses show PA prevalence of 6.8-10 percent in hypertensive groups, rising over 50 percent in resistant hypertension. Diagnostic and population differences cause varied detection, highlighting the need for standard screening. PA rates might increase in patients with higher reno-cardiometabolic compromise. Aldosterone excess promotes cardiovascular remodeling and arrhythmias, so early PA diagnosis in these groups can improve outcomes. Although current guidelines recommend broad screening for PA, particularly in high-risk patients, there is a growing trend toward universal screening in all individuals with hypertension. PA also occurs in mild or normotensive individuals (>10 percent prevalence), so many hypertensives qualify for screening. Adhering to guidelines supports screening nearly all hypertensives for timely diagnosis and treatment.

PA is a common, clinically important yet often missed cause of hypertension, affecting resistant, mild, and normotensive cases. It is prevalent among those patients with cardiovascular complications. Guidelines, though recommending targeted screening, effectively endorse broad testing to enhance detection. Expanding screening and standardizing diagnostics are crucial to optimize diagnosis, enable tailored therapy, reduce cardiovascular risk, and improve outcomes.