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Broadening Primary Aldosteronism Screening: Alignment Across Contemporary Guidelines.
Lily Owei1, Heather Wachtel1, Jordana B Cohen2
1Department of Surgery (L.O., H.W.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Hypertension (Dallas, Tex. : 1979)
|February 6, 2026
Summary
Screening for primary aldosteronism is underutilized, yet early detection significantly lowers cardiovascular and kidney disease risk. Updated guidelines promote broader screening in hypertensive patients to improve outcomes.
Area of Science:
- Endocrinology
- Cardiology
- Nephrology
Background:
- Primary aldosteronism is underdiagnosed, affecting <2% of eligible patients.
- Undetected primary aldosteronism increases cardiovascular and kidney morbidity.
- Recent guidelines advocate for wider screening in hypertension management.
Purpose of the Study:
- To review updated guidelines for primary aldosteronism screening.
- To highlight the benefits of early detection and treatment.
- To discuss implementation strategies and challenges.
Main Methods:
- Analysis of current hypertension and endocrine guidelines.
- Review of epidemiological and cost-effectiveness data.
- Examination of electronic health record-based implementation strategies.
Main Results:
- Guidelines now recommend screening for stage 2 hypertension and all hypertensive individuals.
- Aldosterone-to-renin ratio remains the preferred initial test.
- Electronic health record strategies show promise for increasing screening uptake.
Conclusions:
- Broader screening for primary aldosteronism is recommended.
- Early detection and treatment can reduce cardiorenal disease.
- Implementation innovations are crucial for improving diagnostic pathways.
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