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Renin-aldosterone testing: The essentials

Eunice K T Phillips1, Abilash Sathyanarayanan2

  • 1Oxford University School of Medicine & Biomedical Sciences, University of Oxford, Oxford, UK.

Clinical Medicine (London, England)
|April 4, 2026
PubMed

Insights

Primary Aldosteronism (PA), a common cause of hypertension, is underdiagnosed. Early screening and treatment significantly reduce cardiovascular and renal risks in affected patients.

Area of Science:

  • Endocrinology
  • Cardiology
  • Nephrology

Background:

  • Primary Aldosteronism (PA) is an underdiagnosed cause of secondary hypertension, affecting approximately 9.4% of hypertensive adults.
  • PA patients have significantly higher risks of adverse cardiovascular and renal outcomes.
  • Early diagnosis and treatment can substantially mitigate these risks.

Purpose of the Study:

  • To provide a practical, evidence-based approach for PA screening in generalist settings.
  • To focus on contemporary test interpretation and common pitfalls in PA diagnosis.
  • To encourage improved screening rates for greater global health benefit.

Main Methods:

  • Screening involves a simple blood test measuring plasma aldosterone and renin levels.
  • The diagnostic hallmark is renin-independent aldosterone production, indicated by suppressed renin.
  • Initial testing is recommended on the current antihypertensive regimen, with medication withdrawal if results are inconclusive.

Main Results:

  • Renin-independent aldosterone production is the key diagnostic indicator.
  • Most antihypertensive medications can interfere with initial test results.
  • Specialist referral is indicated for suspected PA or complex cases, such as those with chronic kidney disease.

Conclusions:

  • Improving PA screening offers a significant opportunity to reduce hypertension-related morbidity and mortality globally.
  • Practical screening guidelines are essential for generalist settings to address the underdiagnosis of PA.
  • Timely diagnosis and targeted treatment of PA are crucial for mitigating adverse patient outcomes.

Keywords:
HypertensionHypokalaemiaPrimary aldosteronismReninScreeningSpironolactone

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