People with hypertension with one or more of the following:
should have hyperaldosteronism screening with plasma aldosterone:renin activity ratio.
Whelton PK, Carey RM, Aronow WS, Casey Jr DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith Jr SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams Sr KA, Williamson JD, Wright Jr JT, 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, Journal of the American College of Cardiology (2017), doi: 10.1016/j.jacc.2017.11.006
In adults with hypertension, screening for primary aldosteronism is recommended in the presence of any of the following concurrent conditions: resistant hypertension, hypokalemia (spontaneous or substantial, if diuretic induced), incidentally discovered adrenal mass, family history of early-onset hypertension, or stroke at a young age (<40 years).
Use of the plasma aldosterone: renin activity ratio is recommended when adults are screened for primary aldosteronism (1).
Leung AA, Nerenberg K, Daskalopoulou SS, et al. Hypertension Canada’s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol. 2016; 32(5): 569-588. doi: 10.1016/j.cjca.2016.02.066.
Hyperaldosteronism: screening and diagnosis
1. Screening for hyperaldosteronism should be considered for the following patients (Grade D):
i. Hypertensive patients with unexplained spontaneous hypokalemia (K+ < 3.5 mmol/L) or marked diuretic-induced hypokalemia (K+ < 3.0 mmol/L);
ii. Patients with hypertension refractory to treatment with 3 drugs;
iii. Hypertensive patients found to have an incidental adrenal adenoma.
Screening for hyperaldosteronism should include assessment of plasma aldosterone and plasma renin activity or plasma renin.