Who should be tested for PA?

If you have high blood pressure (hypertension), you may have primary aldosteronism. While some advocate systematic screening, the current consensus is to prioritize testing with patients who have:

• Resistant hypertension:
  • Those patients with sustained blood pressure above 150/100 mm Hg on each of three measurements obtained on different days, or
  • Patients with hypertension (blood pressure >140/90 mm Hg) resistant to three conventional antihypertensive drugs (including a diuretic), or
  • Patients with controlled hypertension (<140/90 mg Hg) on four or more blood pressure medications.
• Hypertension and spontaneous or diuretic-induced hypokalemia (i.e., low potassium).
• Hypertension and an adrenal “incidentaloma.” That is, if you have high blood pressure and when you had a CT scan for some other reason, you were told that there is a nodule or bump on one of your adrenal glands.
• Hypertension and sleep apnea. If you have high blood pressure and have been diagnosed with obstructive sleep apnea (OSA) or sleep apnea is highly suspected.
• Hypertension and a family history of early onset hypertension or stroke at a young age (<40 years). You should also consider getting tested if you are under 40 and have been diagnosed with high blood pressure even if you are unsure about your family history.
• Hypertension and a first degree relative with primary aldosteronism. If you have high blood pressure and someone in your immediate family has primary aldosteronism, you should be tested.