Evaluation and Management of Primary Hyperaldosteronism

Turkish Society of Cardiology Consensus Paper on Evaluation and Treatment of Resistant Hypertension

“…Although the prevalence of PA varies among studies, it is generally reported to be about 20% in patients with RHT ( 57 ). Since delayed diagnosis may have a significant impact on patient outcome, all patients with confirmed RHT should be screened for PA ( 58 , 59 ). Also, hypertensive patients with spontaneous or diuretic-induced hypokalemia, adrenal incidentaloma, or sleep apnea should be screened for PA. A family history of early-onset hypertension or cerebrovascular accident at a young age should alert the physicians on PA.…”

“…Although hypokalemia is an important sign of PA, many of the patients with PA have normokalemia ( 63 ). The ratio of plasma aldosterone concentration to plasma renin activity (ARR) is therefore recommended as an initial screening test ( 58 ). Patient preparation before measuring ARR is very important to avoid inaccurate results ( 58 ).…”

“…The ratio of plasma aldosterone concentration to plasma renin activity (ARR) is therefore recommended as an initial screening test ( 58 ). Patient preparation before measuring ARR is very important to avoid inaccurate results ( 58 ). The patient’s position (patient should be in a supine or sitting position for at least 60 minutes before sampling), diet (patient should be on an unrestricted salt diet), and potassium level (potassium deficiency should be corrected) before testing are important factors to take into account for accurate measurements.…”

“…The patient’s position (patient should be in a supine or sitting position for at least 60 minutes before sampling), diet (patient should be on an unrestricted salt diet), and potassium level (potassium deficiency should be corrected) before testing are important factors to take into account for accurate measurements. Commonly used antihypertensive medications can also affect ARR testing ( 58 , 59 ). Mineralocorticoid receptor antagonists should be withdrawn for at least 4 weeks before testing ( 59 ).…”

“…After the diagnosis of PA is established, it is crucial to investigate the specific etiology of PA, to decide on the appropriate treatment, which can either be surgical or medical. Imaging modalities and adrenal venous sampling are used if necessary, to distinguish between unilateral and bilateral diseases ( 58 , 59 ).…”