Physician Update: AHA Special Edition
Read more articles from our most relevant research presented at the 2025 AHA Scientific Sessions.
Comprehensive Heart and Vascular Center
A Simplified Approach to Evaluation When Primary Aldosteronism Is Suspected
By Wanpen Vongpatanasin, M.D., FACC, FAHA
Professor of Internal Medicine
Director of the Hypertension Section
Primary aldosteronism (PA), an endocrine disorder characterized by excessive aldosterone production from the adrenal gland, is a common cause of resistant hypertension and low-renin hypertension. Patients with PA experience high cardiovascular complications that are out of proportion to the levels of blood pressure alone. However, the screening rate for the at-risk population remains suboptimal, partly due to confusion regarding the population that should be screened and the proper way to conduct screening. In the 2025 AHA/ACC Hypertension Guideline as well as the Endocrine Society guidelines, it is now recommended that all resistant hypertension should be screened regardless of whether hypokalemia is present.
At #AHA25, I presented a simplified approach to evaluating PA, which can easily be adopted into clinical practice. Patients with resistant hypertension and an aldosterone level of > 7.5 ng/dL by tandem mass spec assay or > 10 ng/dL by immunoassay with appropriately suppressed renin and/or presumptive evidence for PA should undergo additional testing. They can be evaluated at a referral center such as ours at UT Southwestern for advanced testing such as adrenal vein sampling.
“Early diagnosis and treatment may lead to improvement in BP control with fewer medications, reduction in hypertensive-related target organ damage, and quality of life.”
Wanpen Vongpatanasin, M.D., FACC
In addition, screening can be performed while the patient is on most antihypertensive medications except for mineralocorticoid receptor antagonists. The new recommendations should increase the rates of screening and improve BP control as well as cardiovascular outcomes in the at-risk population. Early diagnosis and treatment may lead to improvement in BP control with fewer medications, reduction in hypertensive-related target organ damage, and quality of life. In our experience, approximately 10% of patients are able to discontinue all antihypertensive therapy when diagnosis and intervention take place before development of chronic kidney disease occurs.
