PA Screening in Resistant HTN — EECC MCQ

Correct answer: A — Primary aldosteronism — found in 5-20% of patients with resistant hypertension; screening involves the aldosterone-to-renin ratio (ARR)

Primary aldosteronism (PA) is the most common secondary cause of hypertension, found in approximately 5-10% of all hypertensives and up to 20% of those with resistant hypertension. The 2024 ESC Hypertension Guidelines recommend PA screening in: (1) resistant hypertension; (2) hypokalaemia (spontaneous or diuretic-induced); (3) adrenal incidentaloma; (4) young-onset hypertension (<40 years); (5) family history of early-onset hypertension or stroke <40 years. Screening test: ARR (aldosterone-to-renin ratio) — measured under standardised conditions (correct posture, adequate potassium replacement, appropriate medication adjustments). An elevated ARR requires confirmatory testing (saline infusion test or fludrocortisone suppression). Other secondary causes to consider: renal artery stenosis, phaeochromocytoma, Cushing syndrome, coarctation, and obstructive sleep apnoea.

Reference: ESC (2024): Hypertension Guidelines