The Curbsiders Internal Medicine Podcast #386 Primary Aldosteronism, MRAs, and Renovascular Hypertension: NephMadness Pod Crawl 2023
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Mar 20, 2023 AI Snips
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Screen For Primary Aldosteronism Early
- Do screen for primary aldosteronism (PA) in patients with resistant hypertension by ordering morning renin and aldosterone.
- Do not require stopping all antihypertensives to screen; suppressed renin on ARB/thiazide is highly suggestive of PA.
PA Pathophysiology And Outcomes
- Primary aldosteronism often presents as inappropriate aldosterone production that causes salt retention and potassium loss, driving hypertension.
- About half of cases are unilateral adenomas (surgical) and half are bilateral hyperplasia (medical therapy).
Optimize Diuretic And Add SGLT2 In CKD
- Switch hydrochlorothiazide to chlorthalidone 25 mg for more potent, renoprotective BP lowering in CKD.
- Add an SGLT2 inhibitor for CKD with albuminuria, which also helps offset potassium rises when starting MRAs.