Current Hypertension Reports · Nov 3, 2026

Primary Aldosteronism: Evaluation and Management in the Hypertensive Patient

By Balhara M, Owei L, Demko J et al.

Purposeof Review: Primary aldosteronism (PA) is common, underdiagnosed, and associated with excess cardiorenal risk. We review recent changes in screening, diagnosis, treatment, and implementation. Recent Findings: Contemporary guidelines have broadened screening and reduced barriers to aldosterone-to-renin ratio testing through medication-tolerant, assay-aware interpretation. Confirmatory aldosterone suppression testing is increasingly de-emphasized, with selective use or omission in high-probability patients when results are unlikely to change management. Adrenal vein sampling remains standard for most surgical candidates, while molecular imaging is emerging as a noninvasive alternative. Adrenalectomy is preferred for lateralizing disease; mineralocorticoid receptor antagonists remain first-line therapy for bilateral or nonoperative disease, with renin response increasingly used to assess dosing adequacy. Finerenone and aldosterone synthase inhibitors are potential emerging options. Summary: PA care is shifting from a rigid multistep workup toward earlier detection and treatment-directed evaluation. Future work should define scalable screening pathways and compare outcomes of emerging diagnostic and therapeutic strategies.

doi.org/10.1007/s11906-026-01399-yOpen accessPubMed 42975752Interventions