Screening should include measuring aldosterone and renin and determining the aldosterone-to-renin ratio
By Elana Gotkine HealthDay Reporter
FRIDAY, July 18, 2025 (HealthDay News) — All individuals with hypertension should be screened for primary aldosteronism (PA), according to a clinical practice guideline issued by the Endocrine Society and published online July 14 in the Journal of Clinical Endocrinology & Metabolism. The guideline was published to coincide with ENDO 2025, the annual meeting of the Endocrine Society, held from July 12 to 15 in San Francisco.
Gail K. Adler, M.D., Ph.D., from Brigham and Women’s Hospital in Boston, and colleagues developed an updated guideline for identifying and managing PA to improve diagnosis rates and encourage targeted treatment.
The authors suggest screening all individuals with hypertension for PA by measuring aldosterone and renin and determining the aldosterone-to-renin ratio, with the results guiding subsequent clinical care. Individuals with PA should receive medical or surgical PA-specific therapy. In individuals who screen positive for PA, commencement of PA-specific medical therapy is suggested in those who do not desire or are not candidates for surgery and in situations where the probability of lateralizing PA is low based on screening results. Aldosterone suppression testing is suggested in situations in which screening results indicate an intermediate probability for lateralizing PA and patients wish to pursue eligibility for surgical therapy. Adrenal lateralization with computed tomography scanning and adrenal venous sampling is suggested prior to deciding the treatment approach in those who test positive by aldosterone suppression testing and in those in whom screening results show a high probability of lateralizing PA. In the medical treatment of PA, mineralocorticoid receptor antagonists are suggested over epithelial sodium-channel inhibitors.
“With a low-cost blood test, we could identify more people who have primary aldosteronism and ensure they receive the proper treatment for the condition,” Adler said in a statement.
Several authors disclosed ties to the pharmaceutical and biotechnology industries.
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