Minireview: Primary Aldosteronism—Changing Concepts in Diagnosis and Treatment

Primary aldosteronism affects 5–13 % of patients with hyper-tension. Patients with hypertension and hypokalemia and most patients with treatment-resistant hypertension should undergo screening for primary aldosteronism with a plasma aldosterone concentration to plasma renin activity ratio. A high plasma aldosterone concentration to plasma renin ac-tivity ratio is a positive screening test result, a finding that warrants confirmatory testing. For those patients that want to pursue a surgical cure, the accurate distinction between the subtypes (unilateral vs. bilateral adrenal disease) of pri-mary aldosteronism is a critical step. The subtype evaluation may require one or more tests, the first of which is imaging the adrenal glands with computed tomography, followed by se-lective use of adrenal venous sampling. Because of the dele-terious cardiovascular effects of aldosterone, normalizatio