- Primary aldosteronism can be a cause of secondary hypertension, and clinicians need to be aware of when to evaluate for this possibility, say these authors.
- In fact, it can be the culprit in up to 1 in 10 cases of hypertension, presenting a curable cause.
Why this matters
- Guidelines call for clinicians to evaluate for primary aldosteronism if hypertension remains severe despite triple concurrent therapy or if 4 or more drugs are required to control it.
- In addition to resistant hypertension, other hints at primary aldosteronism in patients with hypertension are hypokalemia, sleep apnea, or a family history of early-onset hypertension or primary aldosteronism.
- The authors describe a case of a woman, age 63 years, with 3-decade history of hypertension.
- She was taking 3 medications without controlled BP.
- History of stroke 15 years before.
- Testing showed hypokalemia, which persisted despite cessation of diuretic, triggering evaluation for primary aldosteronism, which was confirmed.
- The condition was the result of a CT-identified left adrenal adenoma, which was removed.
- Removal returned her BP to normal, allowing discontinuation of all antihypertensives.
- The authors suggest that had screening been done appropriately and her primary condition treated, she might have been spared the stroke.
- They note that about 15% of patients with hypertension have it secondary to some primary condition.
- A decision-making flowchart is included.