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Expanded screening using the Vaidya & Carey algorithm significantly improved primary aldosteronism detection in patients with obstructive sleep apnea and hypertension. 

Researchers conducted a retrospective study published in June 2025 in the issue of Endocrine to assess whether expanding screening criteria could enhance the detection of primary aldosteronism (PA) and reduce untreated cases of secondary hypertension (HTN). 

They analyzed PA screening practices in 457 adults diagnosed with both obstructive sleep apnea (OSA) and HTN. Screening was performed in 97 individuals (21%) using serum aldosterone, aldosterone-to-plasma renin activity ratio (ARR), and plasma renin activity (PRA). Screening outcomes were evaluated using 2 methods: the 2016 Endocrine Society guidelines (serum aldosterone and ARR) and the Vaidya & Carey algorithm (serum aldosterone and PRA). 

The results showed that the screened population was mostly male, with a mean age of 58.6 years, and common comorbidities included hyperlipidemia (80%) and diabetes mellitus (31%). The PA positivity was 7% based on the Endocrine Society criteria and 33% with the Vaidya & Carey algorithm. Among those who tested negative using the Endocrine Society guidelines, 26% were reclassified as positive, and 11 indeterminate cases were labeled negative due to lack of renin suppression. When a stricter PRA suppression threshold was applied, 25% screened positive using the Vaidya & Carey algorithm. 

Investigators concluded that the Vaidya & Carey algorithm enhanced the detection of previously unrecognized PA and clarified indeterminate diagnoses, supporting the need for broader screening strategies. 

Source: link.springer.com/article/10.1007/s12020-025-04322-8