Open Letter to the Healthcare Community

  1. A paradigm shift is needed to properly address hypertension and one of its most acute forms – primary aldosteronism.
  2. For the first time since the disease’s discovery over half a century ago, The Unrecognized Prevalence of Primary Aldosteronism has demonstrated that excess aldosterone is likely a primary cause of hypertension. According to the study, up to 50% of hypertensives are affected.
  3. By doing so, the study has framed the context needed to develop an appropriate understanding of the issues at stake: aldosterone remains to be fully understood, and excess hormonal levels remain to be adequately defined and quantified.
  4. Public health progress won’t be made as long as the resources needed to solve these core issues are lacking. Large-scale answers are needed to address hypertension and primary aldosteronism, including their gender and racial components.
  5. Adequately addressing issues the magnitude and complexity of excess aldosterone requires deliberate consensus on and coordination of research to develop and deliver an effective agenda that will generate meaningful results, and translate them into practicable solutions.
  6. Until such time, the Primary Aldosteronism Foundation asks the Endocrine Society, the US National Institutes of Health, and all organizations involved in the research and management of hypertension and primary aldosteronism to:
    • Acknowledge that excess aldosterone is likely a primary cause of hypertension;
    • Update diagnosis criteria according to the findings of The Unrecognized Prevalence of Primary Aldosteronism;
    • Acknowledge the need to simplify and standardize the diagnosis process;
    • Update treatment criteria to acknowledge the limitations of the only solution available to the majority of patients affected by primary aldosteronism (i.e. steroidal MRAs), and that superior medical treatments are needed;
    • Update treatment criteria to acknowledge the challenges of adrenalectomies and that additional surgical options are needed;
    • Update treatment criteria to emphasize dietary sodium restriction along with proactive and coordinated team-based management of comorbidities associated with hypertension in general, and primary aldosteronism in particular;
    • Join our call for inclusion of patients with primary aldosteronism in clinical trials of all drugs targeting excess aldosterone, as opposed to limiting these studies and drug approvals to conditions present in the more advanced stages of the disease (e.g. diabetes, kidney and heart disease);
    • Join our call to action to establish comprehensive national and international registries to facilitate systematic sharing of data on primary aldosteronism; and
    • Join our call to action to dedicate the needed funding to these issues, e.g. in the US, allocation of a minimum of 40% of the NIH hypertension budget to aldosterone research.
  7. Unless and until the knowledge gap is adequately bridged, the Primary Aldosteronism Foundation advocates the identification of affected patients by all means necessary to diagnose and treat them using up-to-date and optimal methods.

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