Diagnosis and Treatment of Primary Aldosteronism. A Single-Center Study

Abstract Primary aldosteronism (PA) is defined as the partial or complete renin-independent secretion of aldosterone. Despite its association with increased cardiovascular risk, PA remains substantially underdiag-nosed, and its recognition in routine clinical practice continues to be challenging. The aim of this study was to retrospectively analyze diagnosed cases of PA, characterize their biochemical and clinical features, and assess the effects of targeted therapy. A total of 19 patients diagnosed with primary aldosteronism were included in this retrospective study. Data distribution was assessed using the Shapiro–Wilk test. Depending on data distribution, parametric or non-parametric statistical tests were used for group comparisons, with statistical significance defined as p < 0.05. The mean age of the patients was 57.26 ± 14.32 years; 7 were male and 12 were female. Baseline systolic blood pressure ranged from 140 to 180 mmHg. Resistant hypertension was present in 89% of patients, and 68.4% required four or more antihypertensive agents to achieve adequate blood pressure control. A positive family history of hypertension, myocardial infarction, or stroke was identified in 11 cases (57.89%). In addition to hypertension, hypokalemia also raised suspicion of PA, occurring in 13 patients, with a mean serum potassium level of 2.38 ± 0.72 mmol/L; in 6 cases (31.58%), hypokalemia was severe (<2.5 mmol/L). The aldosterone-to-renin ratio exceeded the diagnostic threshold in most patients. Computed tomography revealed unilateral or bilateral adrenal abnormalities, with a mean maximum lesion diameter of 21.53 ± 15.97 mm. Surgical treatment was performed in 12 patients. Following surgery, the mean systolic blood pressure measured by ambulatory blood pressure monitoring was 130 ± 11.44 mmHg. Statistical analysis demonstrated a significant reduction in systolic blood pressure compared with preoperative values (p < 0.0001), with a mean decrease of 50.79 mmHg. Our findings suggest that primary aldosteronism is frequently diagnosed only after the development of resistant hypertension and hypokalemia. In our cohort, targeted medical and surgical treatment was associated with favorable clinical outcomes and significant blood pressure reduction. These findings underscore the importance of early recognition and targeted diagnostic evaluation of primary aldosteronism in the management of patients with resistant hypertension.