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Arterial hypertension is an important predictor of cardiovascular morbidity and mortality (1, 2, 3). Patients with primary aldosteronism experience severe hypertension that is caused by excessive aldosterone secretion (4). Moreover, patients with primary aldosteronism exhibit higher rates of cardio-vascular events and end-organ damage than patients with essential hypertension (5, 6). In screening for primary aldosteronism, the aldoster-one-to-renin ratio (ARR) is widely accepted (7), as it indicates autonomous aldosterone production. While increased ARRs are a hallmark of primary aldoster-onism, they also occur in hypertensive subjects with decreased renin in combination with normal or even decreased aldosterone levels (8). The underlyin