Mineralocorticoid hypertension

Lancet. 1999 Apr 17;353(9161):1341-7. doi: 10.1016/S0140-6736(98)06102-9.


Hypertension with hypokalaemia and suppression of plasma renin activity is known as mineralocorticoid hypertension. Although mineralocorticoid hypertension accounts for a small number of patients labelled as having "essential" hypertension, it is a potentially reversible cause of high blood pressure. The most common cause of mineralocorticoid hypertension is probably primary aldosteronism; controlled posture studies to measure plasma renin activity and aldosterone concentrations, followed by adrenal imaging, will ensure the differential diagnosis between an aldosterone-producing adenoma and idiopathic adrenal hyperplasia in most cases. Three monogenic forms of mineralocorticoid hypertension have been described: glucocorticoid-suppressible hyperaldosteronism, Liddle's syndrome, and apparent mineralocorticoid excess, which have provided new insights into mineralocorticoid hormone action. Many patients with mineralocorticoid-based hypertension are now known to have normal serum potassium concentrations. Until the true prevalence of primary aldosteronism and monogenic forms of mineralocorticoid hypertension are defined, a high index of suspicion is needed in every hypertensive patient. Hypertensive patients with hypokalaemia, together with those with severe hypertension or a family history of hypertension or stroke, should be screened for mineralocorticoid excess.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Humans
  • Hyperaldosteronism / epidemiology
  • Hyperaldosteronism / genetics*
  • Hypertension / epidemiology
  • Hypertension / etiology*
  • Hypertension / genetics
  • Hypokalemia / genetics
  • Mineralocorticoids* / metabolism
  • Prevalence


  • Mineralocorticoids