Expanding screening of hypertension patients for primary aldosteronism

On this episode, Dr. Greg Hundemar, co-author of the practice paper in CMAJ “Screening for primary aldosteronism in primary care” discusses primary aldosteronism, its implications and the need to expand screening guidelines. 

Primary aldosteronism, also known as primary hyperaldosteronism or Conn's syndrome, is an endocrine disorder where the adrenal glands secrete too much aldosterone, leading to hypertension. This condition was once thought to be a rare cause of hypertension, but recent research shows that it may account for 10-20% of cases.

Classic symptoms of primary aldosteronism include hypertension, low potassium, and metabolic alkalosis. Patients with this condition are at a disproportionately high risk for cardiovascular disease, rapid decline in kidney function, and higher mortality, independent of blood pressure. Early diagnosis and targeted treatments can significantly improve outcomes.

Dr. Hundemar stresses the importance of screening more people with hypertension for primary aldosteronism to diagnose and treat the condition earlier. Current guidelines recommend screening for those with severe or resistant hypertension, hypertension with low potassium, or hypertension with an adrenal nodule. However, Dr. Hundemar advocates for expanding screening for primary aldosteronism in patients with hypertension, as doing so can potentially identify a large number of undiagnosed cases.

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