GUIDELINES - The Endocrine Society

Why is PA important?This condition is important not only because of itsprevalence, but also because PA patients have highercardiovascular morbidity and mortality than age- andsex-matched patients with essential hypertension andthe same degree of blood pressure elevation (21, 22).Furthermore, specific treatments are available thatameliorate the impact of this condition on patientimportantoutcomes.1.0. CASE DETECTION1.1. We recommend the case detection of primaryaldosteronism (PA) in patient groups with relativelyhigh prevalence of PA (listed in Table 1) (Figure 1).(1| ) These include patients with JointNational Commission (JNC) stage 2 (>160–179/100–109 mm Hg), stage 3 (>180/110 mm Hg), ordrug resistant hypertension; hypertension andspontaneous or diuretic-induced hypokalemia;hypertension with adrenal incidentaloma; orhypertension and a family history of early-onsethypertension or cerebrovascular accident at a youngage (180, DBP >110 (10).When systolic and diastolic blood pressures were in different categories, thehigher category was selected to classify the individual’s blood pressure status.Resistant hypertension, defined as SBP >140 and DBP >90 despite 17%–23%treatment with three hypertensive medications. The prevalence rates citedhere are from (26–31).Hypertensive patients with spontaneous or diureticinducedPA is hypokalemia.Specific prevalence figures are not available,but more frequently found in this group.Hypertension with adrenal incidentaloma (32–37), defined as an Median: 2% (range, 1.1%–10%)adrenal mass detected incidentally during imaging performed for extra- One retrospective study that excluded patientsadrenal reasons.with hypokalemia and severe hypertensionfound aldosterone-producing adenoma in 16of 1004 subjects (37).6