18
Diagnosis
Primary Aldosteronism
COR LOE
Recommendations
I C-EO In adults with hypertension, screening for primary aldosteronism
is recommended in the presence of any of the following
concurrent conditions: resistant hypertension, hypokalemia
(spontaneous or substantial, if diuretic induced), incidentally
discovered adrenal mass, family history of early-onset
hypertension, or stroke at a young age (<40 years).
I C-LD Use of the plasma aldosterone: Renin activity ratio is
recommended when adults are screened for primary
aldosteronism.
I C-EO In adults with hypertension and a positive screening test for
primary aldosteronism, referral to a hypertension specialist or
endocrinologist is recommended for further evaluation and
treatment.
Renal Artery Stenosis
I A Medical therapy is recommended for adults with atherosclerotic
renal artery stenosis.
IIb C-EO In adults with renal artery stenosis for whom medical
management has failed (refractory hypertension, worsening
renal function, and/or intractable HF) and those with
nonatherosclerotic disease, including fibromuscular dysplasia,
it may be reasonable to refer the patient for consideration of
revascularization (percutaneous renal artery angioplasty and/or
stent placement).
Obstructive Sleep Apnea
IIb B-R In adults with hypertension and obstructive sleep apnea, the
effectiveness of continuous positive airway pressure (CPAP) to
reduce BP is not well established.
