• Figure 1.

    Proposed modifications to the diagnostic approach to detect overt and milder forms of primary aldosteronism. Biochemical screening for primary aldosteronism is generally pursued when classical indications are observed, as recommended by the Endocrine Society. A positive screen for primary aldosteronism should suggest reninindependent aldosterone secretion, whereby aldosterone levels are relatively high in the context of a suppressed renin. In the absence of overt evidence for renin-independent aldosteronism on screening, confirmatory testing can be used to affirm the diagnosis. Failure or relative failure to suppress aldosterone on dynamic testing may confirm the diagnosis, whereas marked suppression of aldosterone may instead suggest a diagnosis of low-renin hypertension. Modified from Vaidya et al. (19). Created using BioRender.com.

  • 1.

    Murphy D, et al. The LIFT trial: Study protocol for a double-blind, randomised, placebo-controlled trial of K+-binder Lokelma for maximisation of RAAS inhibition in CKD patients with heart failure. BMC Nephrol 2021; 22:254. doi: 10.1186/s12882-021-02439-2

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Bhatt DL, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med 2014; 370:13931401. doi: 10.1056/NEJMoa1402670

  • 3.

    Böhm M, et al. Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): A multicentre, randomised, sham-controlled trial. Lancet 2020; 395:14441451. doi: 10.1016/S0140-6736(20)30554-7

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Kandzari DE, et al. Effect of renal denervation on blood pressure in the presence of antihypertensive drugs: 6-Month efficacy and safety results from the SPYRAL HTN-ON MED proof-of-concept randomised trial. Lancet 2018; 391:23462355. doi: 10.1016/S0140-6736(18)30951-6

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Azizi M, et al. Six-month results of treatment-blinded medication titration for hypertension control following randomization to endovascular ultrasound renal denervation or a sham procedure in the RADIANCE-HTN SOLO trial. Circulation 2019; 139:25422553. doi: 10.1161/CIRCULATIONAHA.119.040451.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Zhang W, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med 2021; 385:12681279. doi: 10.1056/NEJMoa2111437

  • 7.

    Agarwal R, et al. Chlorthalidone for hypertension in advanced chronic kidney disease. N Engl J Med [published online ahead of print November 5, 2021]. doi: 10.1056/NEJMoa2110730; https://www.nejm.org/doi/10.1056/NEJMoa2110730

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    SPRINT Research Group, et al. Final report of a trial of intensive versus standard blood-pressure control. N Engl J Med 2021; 384:19211930. doi: 10.1056/NEJMoa1901281

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Neal B, et al. Effect of salt substitution on cardiovascular events and death. N Engl J Med 2021; 385:10671077. doi: 10.1056/NEJMoa2105675

  • 10.

    Ma Y, et al. 24-Hour urinary sodium and potassium excretion and cardiovascular risk. N Engl J Med [published online ahead of print November 13, 2021]. doi: 10.1056/NEJMoa2109794; https://www.nejm.org/doi/10.1056/NEJMoa2109794

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Chow CK, et al. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): A phase 3, randomised, double-blind, active-controlled trial. Lancet 2021; 398:10431052. doi: 10.1016/S0140-6736(21)01922-X

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Egan BM, et al. Hypertension control in the United States 2009 to 2018: Factors underlying falling control rates during 2015 to 2018 across age- and race-ethnicity groups. Hypertension 2021; 78:578587. doi: 10.1161/HYPERTENSIONAHA.120.16418

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Bress AP, et al. Inequities in hypertension control in the United States exposed and exacerbated by COVID-19 and the role of home blood pressure and virtual health care during and after the COVID-19 pandemic. J Am Heart Assoc 2021; 10:e020997. doi: 10.1161/JAHA.121.020997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Williams B, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): A randomised, double-blind, crossover trial. Lancet 2015; 386:20592068. doi: 10.1016/S0140-6736(15)00257-3

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Bakris GL, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med 2020; 383:22192229. doi: 10.1056/NEJMoa2025845

  • 16.

    Cohen JB, et al. Testing for primary aldosteronism and mineralocorticoid receptor antagonist use among U.S. veterans: A retrospective cohort study. Ann Intern Med 2021; 174:289297. doi: 10.7326/M20-4873

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Hundemer GL, et al. Screening rates for primary aldosteronism among individuals with hypertension plus hypokalemia: A population-based retrospective cohort study. Hypertension [published online ahead of print October 18, 2021]. doi: 10.1161/HYPERTENSIONAHA.121.18118; https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.121.18118

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Brown JM, et al. The unrecognized prevalence of primary aldosteronism: A cross-sectional study. Ann Intern Med 2020; 173:1020. doi: 10.7326/M20-0065

  • 19.

    Vaidya A, et al. The expanding spectrum of primary aldosteronism: Implications for diagnosis, pathogenesis, and treatment. Endocr Rev 2018; 39:10571088. doi: 10.1210/er.2018-00139

    • PubMed
    • Search Google Scholar
    • Export Citation

Hypertension 2022: Nephrologists in Charge

Kenar Jhaveri Kenar D. Jhaveri, MD, is Professor of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and an attending nephrologist at Northwell Health, Long Island, NY, and is editor-in-chief of ASN Kidney News.

Search for other papers by Kenar Jhaveri in
Current site
Google Scholar
PubMed
Close
Restricted access
Save