Primary Aldosteronism: A Glimpse into the Most Common Endocrine Cause of Arterial Hypertension

Compelling evidences showed that primary aldosteronism (PA) is a quite common disease. In spite of this, hypertensive patients are seldom screened for PA and, therefore, many patients are mislabelled as (low-renin) essential hypertension thereby remaining exposed to the nefarious consequences of long-term hyperaldosteronism. In this chapter we reviewed the clinical aspects of PA and the evidences supporting the need of implementing strategies aimed at diagnosing early PA patients. After reporting the prevalence rates of PA in different cohorts of hypertensive patients, we examined the reasons why PA is rarely searched for. The cardiovascular and renal damage associated with PA were also discussed, with particular emphasis to endothelial dysfunction, vascular remodeling, left ventricular changes, fibrosis, diastolic dysfunction, atrial fibrillation and chronic kidney disease. Studies supporting the concept that PA-associated organ damage can be prevented and even regressed with a timely diagnosis were also reviewed. A flowchart illustrating the proposal of a simplified diagnostic algorithm for screening and subtyping of PA, which allows circumventing the complexity of a diagnostic workup centred on confirmatory tests, is also proposed. Finally, the principles of treatment for PA are discussed.