Considering Primary Aldosteronism in Hypertension Evaluation

Background: Hypertension (HTN) is the most common preventable cause of chronic kidney disease (CKD), cardiovascular disease (CVD), and cognitive impairment. Primary aldosteronism is the most common secondary cause of HTN and requires specific therapy. Several studies show screening for primary aldosteronism is underused, leading to delays in diagnosis and treatment. Objective: To review and summarize literature relating to screening and treatment of primary aldosteronism in HTN. Design: Literature review. Discussion: Screening rates for primary aldosteronism are lower than prevalence rates in several studies. The prevalence of primary aldosteronism may be as high as 20% in some populations and between 2.50% and 3.31% in hospitalized patients and those with hypertensive emergency or urgency. Several studies have shown screening rates of only 1.3% to 2.1% among those with resistant HTN and 2.7% in those with HTN and low potassium. Hospitalists may avoid screening because HTN is common, more...