Primary Aldosteronism: Practical Approach to Diagnosis and Management

Circulation. 2018 Aug 21;138(8):823-835. doi: 10.1161/CIRCULATIONAHA.118.033597.

Abstract

Primary aldosteronism (PA) is the most common form of secondary hypertension. In many cases, somatic mutations in ion channels and pumps within adrenal cells initiate the pathogenesis of PA, and this mechanism might explain why PA is so common and suggests that milder and evolving forms of PA must exist. Compared with primary hypertension, PA causes more end-organ damage and is associated with excess cardiovascular morbidity, including heart failure, stroke, nonfatal myocardial infarction, and atrial fibrillation. Screening is simple and readily available, and targeted therapy improves blood pressure control and mitigates cardiovascular morbidity. Despite these imperatives, screening rates for PA are low, and mineralocorticoid-receptor antagonists are underused for hypertension treatment. After the evidence for the prevalence of PA and its associated cardiovascular morbidity is summarized, a practical approach to PA screening, referral, and management is described. All physicians who treat hypertension should routinely screen appropriate patients for PA.

Keywords: adrenal cortex; aldosterone; hyperaldosteronism; hypertension; receptors, mineralocorticoid; renin; renin-angiotensin system.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adrenal Glands / drug effects
  • Adrenal Glands / metabolism*
  • Adrenal Glands / physiopathology
  • Adrenal Glands / surgery
  • Adrenalectomy
  • Aldosterone / blood*
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure* / drug effects
  • Humans
  • Hyperaldosteronism* / blood
  • Hyperaldosteronism* / epidemiology
  • Hyperaldosteronism* / physiopathology
  • Hyperaldosteronism* / therapy
  • Hypertension* / blood
  • Hypertension* / epidemiology
  • Hypertension* / physiopathology
  • Hypertension* / therapy
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome

Substances

  • Antihypertensive Agents
  • Mineralocorticoid Receptor Antagonists
  • Aldosterone