The high prevalence alongside the established evidence that, compared with essential hypertension, PA exhibits increased left ventricular hypertrophy and renal damage, which translates into additional cardiovascular events, mandates a high degree of alertness and a widespread screening of hypertensive patients, at least those who are young and most likely to benefit from an accurate diagnosis and subtyping of PA. The finding that PA is a frequent cause of secondary hypertension even in a primary care setting and that most PA and APA patients had stage I hypertension along with the evidence that PA confers an increased risk of target organ damage, which can be prevented and regressed with a precocious and specific therapy, either surgical or medical, support the plea for screening all hypertensives with the ARR. Hence, such investigation for secondary hypertension appears sound also in stage I hypertensive subjects, even though the cost-effectiveness of extending the screening for PA in this subgroup of patients remains to be proven.

Authors: Giuseppe Maiolino, Lorenzo A. Calò, Gian Paolo Rossi
Keywords: adrenal vein sampling, aldosterone-producing adenoma, bilateral adrenal hyperplasia, hypertension, renin
DOI Number: 10.1016/j.jacc.2017.02.041      Publication Year: 2017

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