Despite carrying an excess risk of cardiovascular events, primary aldosteronism (PA) is a commonly overlooked secondary form of arterial hypertension. An increased awareness of its high prevalence and broader screening strategies are urgently needed to improve its detection rate and allow early diagnosis and targeted treatment. For patients with unilateral PA, these measures can correct hyperaldosteronism and ensure cure of hypertension, even when resistant to drug treatment, thus preventing adverse cardiovascular events. Among these, atrial fibrillation is the most common, but left ventricular hypertrophy, stroke, chronic kidney disease, and myocardial infarction also occur more often than in patients with hypertension and no PA. Young patients, who have higher chances of being cured long term, and high-risk patients, such as those with stage III or resistant hypertension, are those who will benefit most from an early diagnosis of PA. Therefore, the implementation of strategies to detect PA by a simplified diagnostic algorithm is necessary. In the patients who seek for surgical cure, adrenal vein sampling is key for the identification of unilateral PA and the achievement of optimal outcomes. Unfortunately, being technically demanding and poorly available, adrenal vein sampling represents the bottleneck in the workup of PA. Considering the novel knowledge generated in the past 5 years in many studies, particularly in the AVIS-2 study (Adrenal Vein Sampling International Study-2), based on 4 decades of experience at our center and on the last guidelines, we herein provide an update on the management of PA with recommendations for drug treatment and strategies to avoid adrenal vein sampling wherever it is poorly, or not, available.

中文翻译：

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原发性醛固酮增多症的临床管理：更新。


尽管发生心血管事件的风险过高，但原发性醛固酮增多症 (PA) 是一种常被忽视的继发性动脉高血压。迫切需要提高对其高患病率的认识并采取更广泛的筛查策略，以提高其检出率并实现早期诊断和有针对性的治疗。对于单侧PA患者，这些措施可以纠正醛固酮增多症，确保高血压治愈，即使在药物治疗耐药的情况下也是如此，从而预防不良心血管事件。其中，心房颤动最为常见，但左心室肥厚、中风、慢性肾脏病和心肌梗塞也比高血压且无 PA 的患者更常见。年轻患者长期治愈的机会较高，而高危患者（例如 III 期或顽固性高血压患者）将从早期诊断 PA 中获益最多。因此，有必要实施通过简化的诊断算法来检测PA的策略。对于寻求手术治疗的患者，肾上腺静脉采样对于识别单侧 PA 和实现最佳治疗效果至关重要。不幸的是，由于技术要求高且不易获得，肾上腺静脉采样成为 PA 后处理的瓶颈。考虑到过去 5 年许多研究中产生的新知识，特别是 AVIS-2 研究（肾上腺静脉采样国际研究-2），基于我们中心 4 年来的经验和最新指南，我们在此提供了更新 PA 管理的信息，包括药物治疗建议以及避免肾上腺静脉采样（无论是否可用）的策略。