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.
