A review by an international team of experts coordinated by Dr. André Lacroix, a researcher at the Centre de recherche du CHUM (CRCHUM), highlights a common but widely underdiagnosed cause of high blood pressure in adults: primary aldosteronism.

In many cases, high blood pressure is caused by a little-known hormonal disorder originating in the adrenal glands: primary aldosteronism (PA). Dr. André Lacroix, a researcher in the CRCHUM’s Cardiometabolic Research Theme and an endocrinologist at CHUM, was invited to work with fellow experts to summarize recent advances in our understanding of the causes, complications, diagnosis, and treatment of PA.

Published in the prestigious journal Nature Reviews Disease Primers, the article emphasizes that better screening could help more patients receive treatment that targets the underlying cause of their high blood pressure, while reducing their risk of cardiovascular and kidney complications.

Excessive aldosterone production

Primary aldosteronism occurs when the adrenal glands produce excessive aldosterone, a steroid hormone that plays an essential role in regulating blood pressure and the balance of salts and minerals in the body.

When aldosterone levels are too high, they can cause persistently elevated blood pressure and increase the risk of cardiovascular disease, stroke, abnormal heart rhythms, and kidney damage.

The condition may account for approximately 20% to 30% of cases of high blood pressure. Yet recent studies suggest that fewer than 2% of people with the condition receive a specific diagnosis. As a result, most patients are treated for so-called “essential” hypertension without the true cause of their condition ever being identified.

Better screening, more targeted treatment

One of the review’s key messages is that more systematic screening could significantly change the care pathway for many patients. “A simple blood test to measure aldosterone, renin, and potassium levels is often enough as a first step in screening for this condition,” explains Dr. André Lacroix.

It is then essential to identify the source of the excess aldosterone, since treatment varies depending on the origin. Some forms of PA affect only one adrenal gland and can be treated surgically, while others affect both glands and require targeted medication. In either case, appropriate treatment can reduce the risks associated with chronically elevated aldosterone levels.

For Dr. Lacroix, improving screening is therefore a priority. Identifying PA more effectively could not only allow for more targeted treatment, but also help prevent many of the cardiovascular and kidney complications associated with the condition.