A Systematic Review Supporting the Endocrine Society Clinical Practice Guideline on Management of Primary Aldosteronism.

Context: Primary aldosteronism (PA) is a leading endocrine cause of secondary hypertension.

Objective: To support the development of the Endocrine Society Clinical Practice Guideline on managing PA.

Data source: MEDLINE, Embase, Scopus, and others were searched on October 4, 2024.

Study selection: Studies were selected by pairs of independent reviewers.

Data extraction: Data were extracted and appraised by pairs of independent reviewers.

Data synthesis: We included 95 studies (7 randomized trials and 88 observational studies). We did not identify trials that evaluated the outcomes of PA screening. One observational study suggested that screening was associated with higher rates of using PA-specific medical therapies and better blood pressure control. Patients managed with adrenal venous sampling (vs computed tomography alone) may have a better post-adrenalectomy biochemical cure rate, but with an increased risk of adrenal hemorrhage. Two small observational studies suggested that PA-specific medical or surgical therapy was likely associated with better blood pressure control than nonspecific therapy. Small randomized trials suggested that surgical therapy may be associated with better blood pressure control than medical therapy, with a lower number and dosage of antihypertensive medications. Compared to eplerenone, spironolactone may be associated with better control of hypokalemia and a lower number and dosage of antihypertensive agents. Unsuppressed plasma renin activity was associated with better control of hypokalemia, while suppression was associated with higher risk of mortality, atrial fibrillation, and stroke (very low certainty).

Conclusion: This systematic review addresses various aspects of managing PA and will support the development of the Endocrine Society guidelines.