In terms of clinical guidance, retrospective and now prospective studies provide compelling evidence that surgical treatment of PA is more effective than medical therapy, such that the former should be considered the preferred treatment on demonstration of lateralization of aldosterone excess. In terms of direction, recent retrospective findings suggest that medical therapy of PA might be best guided not just by BP control but by evidence of biochemical efficacy as indicated by the change in renin activity. Given its potential clinical significance, confirming change in renin activity as an index of therapeutic efficacy when treating PA, whether with MRAs or perhaps other classes of agents, including MR-modulating peptides or novel inhibitors of aldosterone synthase, should be a priority of clinical researchers.
