Primary Aldosteronism: a Continuum from Normotension to Hypertension

Purpose of Review Primary aldosteronism (PA) is the most common cause of secondary hypertension. Emerging evidence suggests that PA is associated with cardiovascular, metabolic, and renal complications, that likely develop insidiously, due to prolonged inappropriate mineralocorticoid receptor activation. In this review, we discuss the expanding clinical and pathological spectrum of PA. Recent Findings Clinical and molecular studies conducted over the recent years reveal that PA traverses a series of contiguous stages. Pre-clinical, but hormonally overt PA has been identified in patients with normal blood pressure, and such patients harbor an increased risk of developing hypertension. Similarly, genetic and histopathological advancements have exposed a spectrum of PA pathology that corresponds to a continuum that spans from pre-clinical stages to florid PA. PA evolves from pre-hypertensive stages to resistant hypertension, along with serious cardiovascular and renal consequences. Early recognition of PA and targeted therapy will be essential for cardiovascular morbidity and mortality prevention in a large number of patients.

Automated summary

Recent clinical and molecular studies have shown that primary aldosteronism progresses through a series of stages, from pre-clinical to overt hormonal PA. Advances in genetics and histopathology have revealed a spectrum of PA pathology that spans from pre-clinical stages to severe disease. PA evolves from pre-hypertensive stages to resistant hypertension, with serious cardiovascular and renal consequences. Early recognition and targeted therapy are crucial for preventing cardiovascular morbidity and mortality in many patients.