Primary Aldosteronism More Common Than Previously Believed, Requires Increased Screening

Primary aldosteronism (PA) is significantly more prevalent among patients with incident hypertension than previously believed, according to recent data.1

Presented at the Endocrine Society (ENDO) Annual Meeting 2026 in Chicago, Illinois, by Diana Varghese, MD, an internal medicine fellow at the University of Maryland in Rockville, these data challenge the commonly accepted image of PA as a rare condition with limited impact. Varghese and colleagues hope that the present study encourages further research into more widespread methods of screening.1

“Traditionally, we have always considered primary aldosteronism as a very, very rare condition, but I think that is changing,” Varghese told HCPLive in an exclusive interview. “We know even in primary care practice that the prevalence of primary aldo is 5-10% or even more, and it goes up to even 30% in tertiary care settings. The Endocrine Society guidelines from last year ask for everyone to screen for hypertension – it’s just an acknowledgement of how much we under-screen for this condition.”

Historically, the lack of screening and diagnosis of PA has been attributed in large part to its lack of easily identifiable features. Additionally, given its believed rarity, many clinicians have little exposure to the disease and therefore have limited knowledge regarding its management. The current diagnostic process involves screening, confirmatory testing, and subtype differentiation of unilateral from bilateral forms – the process itself can be fairly invasive, requiring adrenal venous sampling.2

To address these issues, Varghese and colleagues conducted a retrospective cohort study via the Optum Labs Data Warehouse. The team collected data on adults with incident hypertension diagnosed between 2011 and 2023, as well as paired measurements of renin and aldosterone. Suppressed renin was defined as ≤1 ng/mL/h or <8 pg/mL, and positive screening was defined by suppressed renin with aldosterone ≥10 ng/dL. The team employed multivariable regression to identify predictors of positive screens.1

A total of 9414 patients were identified with incident hypertension and laboratory results for paired renin and aldosterone. The mean age among the patients was 52 years (standard deviation [SD], 16 years), 56% were women, and 58% were White. Varghese and colleagues saw positive screening results in 819 patients.1

Multivariable analyses revealed the following factors associated with positive screening:

• Older age compared with age <25 years (ranging OR, 2.46; 95% CI, 1.16-5.21 for ages 25-34 to OR, 4.03; 95% CI, 1.49-10.91 for ages ≥75)
• Female sex (OR, 1.37; 95% CI, 1.16-1.61)
• Hispanic/Latino ethnicity (OR, 1.36; 95% CI, 1.06-1.74)
• Black race (OR, 1.8; 95% CI, 1.42-2.28)
• Asian race (OR, 1.91; 95% CI, 1.39-2.63)
• Hypokalemia (OR, 1.5; 95% CI, 1.19-1.88)
• Diabetes mellitus (OR, 1.26; 95% CI, 1.03-1.54)1

Odds of positive PA screening were lower among patients with heart failure (OR, 0.54; 95% CI, 0.35-0.84). Additionally, positive screening odds were lower with RAAS inhibitors (OR, 0.78; 95% CI, 0.66-0.92) and higher with beta blockers (OR, 1.45; 95% CI, 1.23-1.71), calcium channel blockers (OR, 1.3; 95% CI, 1.1-1.52), and potassium supplementation (OR, 1.66; 95% CI, 1.28-2.16).1

Ultimately, Varghese and colleagues noted that the positive screening rate was 9% among the patients screened in the study. The team also pointed out significant variation across clinical, demographic, and medication-related subgroups. They hope that these findings could inform further screening strategies by providing potential indicators.1

“Because we are now screening more and more people, we have to see what resources are needed to help the clinicians and in general to help with understanding more about this,” Varghese said. “Further studies need to link screening to downstream health outcomes and healthcare utilization, and to assess whether broader or risk-based screening improves PA outcomes.”

Editors’ Note: Varghese reports no relevant disclosures.

References

1. Varghese D, Takagi M, Deng Y, et al. Screening Yield and Predictors of Positive Primary Aldosteronism Screening. Abstract presented at the Endocrine Society (ENDO) Annual Meeting 2026, Chicago, IL. June 13-15, 2026.

2. Reincke M, Bancos I, Mulatero P, Scholl UI, Stowasser M, Williams TA. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol. 2021;9(12):876-892. doi:10.1016/S2213-8587(21)00210-2