DOI: 10.1097/HJH.0b013e32831cf03f

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Issn Print: 0263-6352

Publication Date: 2009/01/01


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Diagnosis of primary aldosteronism: for medical management, not just surgery

Norman Kaplan

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Dr Spence has shown that appropriate use of renin/aldosterone profiling can be clinically useful. Fortunately, he avoids the use of an aldosterone to renin ratio (ARR) that often leads to unnecessary additional testing of those with simply low renin primary (essential) hypertension.
I am not aware of evidence that primary aldosteronism is more prevalent in patients in and from Africa or that the variant of Liddle's syndrome is common except in the population studied by investigators in the UK.
Dr Spence's ability to use medical therapy for 95% of his patients with primary aldosteronism suggests that he proceeds with medical therapy on the basis of an elevated plasma aldosterone and low renin without further testing. Assuming that they respond well, it seems likely that most of his patients have bilateral adrenal hyperplasia. In the future, an aldosterone blocker will likely be used with a diuretic as initial therapy for more and more hypertensive patients, making workup for the possible presence of aldosteronism even less necessary in those who respond well.

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