The Time Has Come for Systematic Screening for Primary Aldosteronism in All Hypertensives


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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