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Evaluation and Diagnosis
3.2.3.1. Primary Aldosteronism
COR LOE
Recommendations
1 C-EO
1. In adults with hypertension, screening for primary
aldosteronism is recommended in the presence of any of the
following conditions to increase rates of detection, diagnosis,
and specific targeted therapy: resistant hypertension
(regardless of whether hypokalemia is present), hypokalemia
(spontaneous or diuretic induced), OSA, incidentally
discovered adrenal mass, family history of early-onset
hypertension, or stroke at a young age (<40 years).
2b C-EO
2. In adults with stage 2 hypertension, screening for primary
aldosteronism may be considered to increase rates of
detection, diagnosis, and specific targeted therapy.
1 C-LD
3. In adults with an indication for screening for primary
aldosteronism, use of plasma aldosterone, renin activity, and
the plasma aldosterone:renin activity ratio is recommended
for initial screening to assess if there is biochemical evidence
of primary aldosteronism.
1 C-EO
4. In adults with an indication for screening for primary
aldosteronism, it is recommended to continue most
antihypertensive medications (other than mineralocorticoid
receptor antagonists [MRA]) prior to initial screening to
minimize barriers to or delays in screening.
1 C-EO
5. In adults with hypertension and a positive screening test
for primary aldosteronism or continued suspicion for
primary aldosteronism based on suppressed plasma renin
or disproportionate target organ damage, referral to a
hypertension specialist or endocrinologist is recommended
for further evaluation and treatment.
