Primary Hyperaldosteronism: Screening, Diagnosis, and Management for the Clinician

Primary hyperaldosteronism (PA) is the most common secondary, non-iatrogenic cause of hypertension. This condition is associated with significant risk of morbidity and mortality, yet it is often unrecognized and undiagnosed in the primary care setting. Screening with the aldosterone to renin ratio (ARR) should be considered in patients with resistant hypertension, defined as blood pressure >140/90 mmHg despite the use of three different classes of antihypertensive medications, including a diuretic. The goal of this review is to inform the primary care clinician of the current guideline recommendations for screening, confirming, subtyping, and treating primary hyperaldosteronism.