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The following is a summary of “Screening for primary aldosteronism in 1,181 Swedish primary care patients with hypertension,” published in the April 2025 issue of Frontiers in Endocrinology by Makhnov et al. 

Primary aldosteronism (PA) was identified as a common cause of hypertension, associated with increased morbidity and mortality, which did not improve adequately with conventional antihypertensive therapy, and screening via plasma aldosterone–renin ratio (ARR) enabled targeted treatment according to Endocrine Society guidelines.  

Researchers conducted a retrospective study to assess the prevalence of PA, factors influencing biochemical diagnostics, and the outcomes of lateralization studies and specific treatments for identified PA cases.  

They screened 1,181 patients for PA using plasma ARR under current therapy, excluding mineralocorticoid receptor antagonists (MRA) and confirmed results with the intravenous saline suppression test (SST#1). Patients with results in the gray zone underwent therapy adjustment and completed a second SST (SST#2). Plasma aldosterone and ARR were compared at different diagnostic stages. All patients with PA were offered adrenal venous sampling or, in some cases, adrenocortical-specific positron emission tomography. Lateralizing cases received laparoscopic adrenalectomy, and bilateral cases were treated with MRA. Treatment outcomes were assessed after a minimum of 6 months.  

The results showed 53 cases of PA, with a prevalence of 4.5%. The initial seated plasma ARR was higher than the recumbent ARR before the SST#1. At SST#2, both initial ARR and final aldosterone were higher than SST#1. Localization studies, accepted by 45 patients, identified 14 lateralized cases. Among the 11 operated patients, 4 had aldosterone-producing adenoma, while the others had micro- and macronodular histopathology. A total of 31 patients had bilateral PA. Both surgical and conservative treatments were well tolerated, improving blood pressure and increasing renin, indicating reduced risk.  

Investigators concluded that PA was prevalent among primary care patients with hypertension and could be screened for under current antihypertensive therapy, with aldosterone-producing adenoma being rare, supporting active screening for appropriate treatment. 

Source: frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2025.1555572/full