Why should I test patients for PA?

According to the Endocrine Society, primary aldosteronism is a major public health issue that affects up to 10% of patients with hypertension. Most patients with hypertension are never screened for primary aldosteronism. As a result, they go untreated for years and often experience end organ damage that could be avoided with earlier detection and treatment. Evidence suggests a higher risk for cardiovascular and renal complications in patients with primary aldosteronism, including arrhythmias, myocardial infarction, stroke, chronic kidney disease and death vs. age-, sex- and BP-matched adults with hypertension. Early detection can improve cardiovascular outcomes.

Testing for primary aldosteronism begins with a test of plasma aldosterone and renin levels. If the aldosterone-to-renin ratio is high, then the patient is likely to have primary aldosteronism and should be promptly referred to a specialist for further testing.

Primary care physicians should always consider primary aldosteronism in the presence of:

• Resistant hypertension
• Hypertension and spontaneous or diuretic-induced hypokalemia
• Hypertension and an adrenal incidentaloma
• Hypertension and sleep apnea
• Hypertension and a family history of early onset hypertension or stroke at a young age (<40 years)
• Hypertension and a first degree relative with primary aldosteronism