[Stratified and graded diagnosis and treatment strategies for patients with primary aldosteronism].

Abstract

Primary aldosteronism (PA) is the most common endocrine cause of secondary hypertension and carries a greater risk of cardiorenal complications than essential hypertension. Recent domestic and international guidelines and consensus statements have proposed screening all patients with hypertension for PA. To cope with the massive patient base resulting from universal screening, this article explores practical schemes for the stratified and graded diagnosis and treatment of PA. By employing "non-drug withdrawal" and "minimal-drug withdrawal" testing protocols, PA screening can be feasibly implemented in primary care settings. Based on simple clinical parameters-including serum potassium, plasma aldosterone levels, and blood pressure-patients are stratified into mild, moderate, and severe categories, along with an estimated probability of unilateral PA. Patients with mild disease, unwilling to undergo surgery, or those who are not surgical candidates can receive medical therapy and follow-up directly at primary care facilities. For moderate-to-severe patients who are willing and eligible for surgery, referral to higher-level hospitals with specialized expertise is indicated, where confirmatory aldosterone suppression testing and adrenal venous sampling are performed for subtype classification. Unilateral disease is treated with surgical resection of the affected adrenal gland, whereas bilateral disease is managed medically. This approach enables timely and appropriate diagnosis and treatment of PA across a broader range of healthcare institutions, fulfilling the paradigm of "universal screening-stratified management-individualized therapy".