Is there an unrecognized epidemic of primary aldosteronism? (Pro)

A large body of evidence clearly establishes that PA is common, with a prevalence of ≈10% among general hypertensive populations and ≈20% among patients with resistant hypertension. Results of the recently published PAPY study indicate that, among patients with general hypertension, <5% will have an APA.11 Given this small percentage, it is not likely to be cost or risk efficient to fully evaluate all patients with hypertension for PA in order identify he few that will benefit for adrenalectomy. In contrast, because patients with resistant hypertension are by definition failing medical therapy, evaluation for PA seems appropriate to identify the 10% who likely have an APA and to guide dosing of mineralocorticoid receptor antagonists in the 10% who have idiopathic PA.