Primary Aldosteronism and Cardiovascular Events: It is time to take guideline recommendations seriously

It is nowadays widely accepted that primary aldosteronism is the most frequent cause of endocrine hypertension. Prevalence rates among patients with hypertension are 6% in the primary care setting and 11% in tertiary care referral centers (1). The 2016 Endocrine Society Practice Guidelines (2) recommend screening of hypertensive subjects with increased pre-test probability which accounts to roughly 50% of all hypertensives. Nevertheless, these recommendations stand isolated and are not fully reflected by current hypertension guidelines in the US or Europe. More importantly, current health care data suggest that little has changed in terms of screening: according to a 2015 survey only 1% of hypertensives are screened in Italy and 2% in Germany by general practitioners (3). It is in this context in the current issue of the journal, that Ohno et al. publish their data from the recently founded Japan Primary Aldosteronism Study (4)