Bilateral aldosterone production is most common in primary aldosteronism found by screening within primary care

OBJECTIVE Primary aldosteronism (PA) is the most common cause of secondary hypertension, and implies high risk of cardiovascular complications. Previously, our group had screened 1181 unselected Swedish primary care hypertensive patients, to find PA prevalence of 4,5%. The current study describes results of further diagnostics and specific treatment of these PA patients. DESIGN Prospective evaluation of lateralization and treatment of patients with PA. PATIENTS Fifty-three individuals with PA diagnosed by screening carried out in strict accordance with the current guidelines. MEASUREMENTS All patients accepting possible surgery underwent adrenal venous sampling, complemented, if unsuccessful, by adrenal cortex-specific positron emission tomography. Lateralizing cases were advised laparoscopic adrenalectomy. Bilateral ones were treated by mineralocorticoid receptor antagonists. Treatment results were assessed by at least 6 - 12 months of follow-up. RESULTS Localizing studies were accepted by 45 patients, 8 patients declined. Lateralized disease was found in 14 cases. Of 11 operated cases 3 had adenoma (prevalence 7-13%). Remaining operated cases comprised micro- and macronodular pathology. Thirty-one patients had bilateral PA. Screening and specific PA treatment led to better blood pressure and raising renin signifying risk amelioration. Both surgical and conservative treatment were tolerated well even when mainly conducted at regional healthcare level. CONCLUSIONS Bilateral production of aldosterone is common in a patient cohort derived from screening within primary care. Lateralization may be due to either adenoma, which is very rare, or due to nodular forms of PA, and both are successfully treated with adrenalectomy. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial ClinicalTrials.gov: [NCT03105531][1] ### Funding Statement The authors have received funding from the Regional Research Council for Uppsala-Örebro (Sweden) as well as from the Center for Clinical Research and Education, Region Värmland, Karlstad (Sweden). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Swedish Ethical Review Authority I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Research data are not shared due to privacy or ethical restrictions. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03105531&atom=%2Fmedrxiv%2Fearly%2F2024%2F02%2F24%2F2024.02.22.24303228.atom