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Primary aldosteronism

Don't miss primary aldosteronism in your patients with hypertension

~120M people are hypertensive in the US1

30% of hypertensive patients in the US may have primary aldosteronism2

<1% of patients with hypertension are screeend for primary aldosteronism3

Primary aldosteronism (PA) is a condition that can lead to serious health complications if patients aren’t screened or are missed with traditional aldosterone renin ratio (ARR) screenings.

PA is underrecognized, resulting in a screening rate of <1% of all hypertensive patients and only 1.6% of patients with resistant hypertension.3

Plasma renin activity (PRA) is a newer screening recommended to improve sensitivity and recognize at-risk patients.

In addition to being underrecognized, primary aldosteronism is also the most common cause of secondary hypertension3

The importance of screening

Patients with untreated PA are at a disproportionately higher risk of cardiovascular, kidney, and metabolic disease when compared to essential hypertensive patients.

These conditions include but are not limited to heart failure, kidney disease, stroke, atrial fibrillation (AF), myocardial infarction, type 2 diabetes mellitus (T2DM), and sleep apnea.4,5

Who should be screened?

PA screening is important for high-risk populations, including those with5,6:

  • Severe or resistant hypertension
  • Unexplained or diuretic-induced hypokalemia
  • Hypertension with adrenal mass
  • Hypertension with sleep apnea
  • Hypertension with atrial fibrillation
  • A strong personal or family history of hypertension

Additionally, there is growing agreement that screening for PA should be expanded to cover a large scope of patients, including those with new onset hypertension.

A study of nearly 95K patients compared ARR vs PRA as screening test for PA and found that 45.9% of patients tested positive

based on suppressed renin of <1 ng/mL/h versus 13.9% of patients based on ARR ≥302

Download key summary

Expert opinion to identify more patients with PA

1. Using PRA to screen for PA, with PRA <1 ng/mL/h as an alternative first step to ARR2

2. Using aldosterone levels as a second step to categorize patients

  • >15 ng/dL: overt primary aldosteronism
  • 5-15 ng/dL: likely primary aldosteronism until proven otherwise
  • <5 ng/dL: primary aldosteronism unlikely, suggesting low renin hypertension

Quest's solution for primary aldosteronism screening

This reflex testing algorithm was developed by Quest Diagnostics based on reference 2. Test selection and interpretation, diagnosis, and patient management decisions should be made based on the physician’s education, clinical expertise, and assessment of the patient.
Plasma Renin Activity (PRA) Reflex to Aldosterone, LC/MS/MS
Plasma Renin Activity, LC/MS/MS
Aldosterone, LC/MS/MS

Read more about primary aldosteronism and Quest's screening solutions

Download brochure
PA brochure thumbnail

 

References 

  1. CDC. Division for Heart Disease and Stroke Prevention. Million Hearts®. Hypertension cascade: hypertension prevalence, treatment, and control estimates among US adults aged 18 years and older applying the criteria from the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2017–2020. Last reviewed May 12, 2023. Accessed September 3, 2024. https://millionhearts.hhs.gov/data-eports/hypertensionprevalence.html
  2. Marcelli M, Bi C, Funder JW, McPhaul MJ. Comparing ARR versus suppressed PRA as screening tests for primary aldosteronism. Hypertension. 2024. doi: 10.1161/HYPERTENSIONAHA.124.22884
  3. Funder JW, Carey RM, Fardella C, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266–3281. doi: 10.1210/jc.2008-0104
  4. Cleveland Clinic. Primary aldosteronism (Conn’s syndrome). Last reviewed July 22, 2024. Accessed September 3, 2024. https://.my.clevelandclinic.org/health/diseases/21061-conns-syndrome 
  5. Hung A, Ahmed S, Gupta A, et al. Performance of the aldosterone to renin ratio as a screening test for primary aldosteronism. J Clin Endocrinol Metab. 2021;106(8):2423–2435. doi: 10.1210/clinem/dgab348
  6. Cobb A, Aeddula NR. Primary hyperaldosteronism. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2024. Last updated December 5, 2023. Accessed September 3, 2024. https://www.ncbi.nlm.nih.gov/books/NBK539779/

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