When to think in primary hyperaldosteronism in case of treatment-resistant hypertension?

Abstract

Primary hypertension is the main form of this disease; the frequency of secondary causes only increases in certain specific clinical scenarios, mainly in referral centers. In high blood pressure grade 3, new onset grade 2 or resistant hypertension, the presence of primary aldosteronism should be suspected. For the correct diagnosis, an established algorithm must be followed, which includes the previous hydration plan, the correct pharmacological management, and the conditions for taking biochemical samples. The gold standard for definitive diagnosis is selective aldosterone dosing in both renal veins. The final treatment will be pharmacological, depending on whether it is bilateral idiopathic hyperplasia or idiopathic aldosteronism, or surgical through laparoscopic adrenalectomy in cases of adenoma or unilateral hyperplasia. The chances of a cure for high blood pressure are low, but intervention allows better hypertension control and management of the metabolic syndrome.