Screen for primary aldosteronism in hypertensive patients
STEP 1 — Gather Information
Confirm hypertension diagnosis using office BP ≥140/90 mmHg on ≥2 occasions, ambulatory BP, or home BP averages; document current antihypertensive medications.
STEP 2 — Rule In / Rule Out
If hypertension is present, proceed to screen for PA; if hypertension is absent, do not screen for PA based on this guideline.
STEP 3 — Classify or Stratify
Classify the patient as indicated for PA screening per Recommendation 1 (all hypertensives should be screened).
STEP 4 — Decide
Order morning seated serum/plasma aldosterone and plasma renin concentration (or activity) with avoidance of dietary sodium restriction prior to testing; measure serum potassium for accurate interpretation.
Clinical Guardrails / Mimics / Pitfalls
Do not rely on hypokalemia to rule out screening; do not delay screening until complications or resistant hypertension develop; avoid withholding screening due to mild or controlled hypertension; consider interfering medications (e.g., β‑blockers, ACEi/ARBs) but still screen, repeating if needed after medication withdrawal.
Concrete Clinical Example
A 58‑year‑old with stage 2 hypertension (BP 165/100 mmHg) on lisinopril and hydrochlorothiazide asks whether they should be screened for PA. According to the guideline, screen all hypertensives, so order aldosterone and renin levels.
Source: Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2025, DOI: 10.1210/clinem/dgaf284