Clinical manifestations of primary aldosteronism and cardiometabolic risk

Primary aldosteronism (PA) is the most common cause of secondary hypertension and is increasingly recognized as a spectrum disorder, ranging from subclinical to overt forms. Clinical manifestations include hypertension, often resistant, and may be accompanied by hypokalemia. Beyond BP elevation, PA is associated with a disproportionately high risk of cardiovascular and metabolic complications compared to essential hypertension, including coronary artery disease, arrhythmias, heart failure, left ventricular hypertrophy, stroke, metabolic syndrome and impaired glucose metabolism. The negative effects of aldosterone excess induce greater target organ damage than seen in primary hypertension, including arterial stiffness, cardiac remodeling, and renal dysfunction. Targeted treatments such as mineralocorticoid receptor (MR) antagonists and adrenalectomy have demonstrated efficacy in reducing these risks and improving patient outcomes. Therefore, early detection and management of PA are essential for preventing long-term cardiovascular and metabolic complications.