Primary Aldosteronism: Evaluation and Management in the Hypertensive Patient
- 1Perelman School of Medicine, Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA USA
- 2Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- 3Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
Abstract
Purposeof Review: Primary aldosteronism (PA) is common, underdiagnosed, and associated with excess cardiorenal risk. We review recent changes in screening, diagnosis, treatment, and implementation.
Recent Findings: Contemporary guidelines have broadened screening and reduced barriers to aldosterone-to-renin ratio testing through medication-tolerant, assay-aware interpretation. Confirmatory aldosterone suppression testing is increasingly de-emphasized, with selective use or omission in high-probability patients when results are unlikely to change management. Adrenal vein sampling remains standard for most surgical candidates, while molecular imaging is emerging as a noninvasive alternative. Adrenalectomy is preferred for lateralizing disease; mineralocorticoid receptor antagonists remain first-line therapy for bilateral or nonoperative disease, with renin response increasingly used to assess dosing adequacy. Finerenone and aldosterone synthase inhibitors are potential emerging options.
Summary: PA care is shifting from a rigid multistep workup toward earlier detection and treatment-directed evaluation. Future work should define scalable screening pathways and compare outcomes of emerging diagnostic and therapeutic strategies.
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BibTeX
@article{balhara2026primary,
title = {{Primary Aldosteronism: Evaluation and Management in the Hypertensive Patient}},
author = {Maria Balhara and Lily Owei and John Demko and Heather Wachtel and Jordana B. Cohen},
journal = {Current Hypertension Reports},
year = {2026},
month = nov,
doi = {10.1007/s11906-026-01399-y},
url = {https://doi.org/10.1007/s11906-026-01399-y},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Primary Aldosteronism: Evaluation and Management in the Hypertensive Patient
AU - Maria Balhara
AU - Lily Owei
AU - John Demko
AU - Heather Wachtel
AU - Jordana B. Cohen
PY - 2026
DA - 2026/11/03
JO - Current Hypertension Reports
DO - 10.1007/s11906-026-01399-y
UR - https://doi.org/10.1007/s11906-026-01399-y
AB - Purposeof Review: Primary aldosteronism (PA) is common, underdiagnosed, and associated with excess cardiorenal risk. We review recent changes in screening, diagnosis, treatment, and implementation. Recent Findings: Contemporary guidelines have broadened screening and reduced barriers to aldosterone-to-renin ratio testing through medication-tolerant, assay-aware interpretation. Confirmatory aldosterone suppression testing is increasingly de-emphasized, with selective use or omission in high-probability patients when results are unlikely to change management. Adrenal vein sampling remains standard for most surgical candidates, while molecular imaging is emerging as a noninvasive alternative. Adrenalectomy is preferred for lateralizing disease; mineralocorticoid receptor antagonists remain first-line therapy for bilateral or nonoperative disease, with renin response increasingly used to assess dosing adequacy. Finerenone and aldosterone synthase inhibitors are potential emerging options. Summary: PA care is shifting from a rigid multistep workup toward earlier detection and treatment-directed evaluation. Future work should define scalable screening pathways and compare outcomes of emerging diagnostic and therapeutic strategies.
SN - 1522-6417
SN - 1534-3111
ER -