Clinical Management of Primary Aldosteronism

2013 Practical Recommendations of the Italian Society of Hypertension (SIIA)


Primary aldosteronism is the most common form of endocrine hypertension and is highly prevalent among patients with difficult to control high blood pressure. In the presence of a high sodium intake primary aldosteronism carries has detrimental effects on the cardiovascular system, which translate into an excess rate of cardiovascular events. Therefore, to prevent these ominous consequences primary aldosteronism should be detected as early as possible and should be accurately diagnosed. Institution of the most appropriate treatment can lead to long-term cure of hypertension and to regression of the cardiovascular changes with a great benefit for the patients. We herein summarize the current evidence-based practical recommendations that will help physicians to diagnose and treat primary aldosteronism properly.


Hypertension Cardiovascular risk Secondary hypertension Endocrine hypertension Aldosteronism-aldosterone/renin ratio Diagnosis Treatment Adrenalectomy Mineralocorticoid receptor antagonists 


  1. 1.
    Bramlage P, Bohm M, Volpe M, Khan BV, Paar WD, Tebbe U, et al. A global perspective on blood pressure treatment and control in a referred cohort of hypertensive patients. J Clin Hypertens (Greenwich). 2010;12(9):666–77.CrossRefGoogle Scholar
  2. 2.
    Ignatius J. “RR 160/80” Scipione Riva-Rocci (1863-1937). Duodecim. 1993;109(17):1493–4.PubMedGoogle Scholar
  3. 3.
    Prugger C, Keil U, Wellmann J, de Bacquer D, de Backer G, Ambrosio GB, et al. Blood pressure control and knowledge of target blood pressure in coronary patients across Europe: results from the EUROASPIRE III survey. J Hypertens. 2011;29(8):1641–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Chobanian AV. Shattuck Lecture. The hypertension paradox—more uncontrolled disease despite improved therapy. N Engl J Med. 2009;361(9):878–87.PubMedCrossRefGoogle Scholar
  5. 5.
    Volpe M, Tocci G, Trimarco B, Rosei EA, Borghi C, Ambrosioni E, et al. Blood pressure control in Italy: results of recent surveys on hypertension. J Hypertens. 2007;25(7):1491–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Hartmann B, Weise H, Bassenge E. Quality assurance in Riva-Rocci blood pressure measurement: simultaneous sphygmomanometry with open and covered pressure display. Z Kardiol. 1988;77(8):537–42.PubMedGoogle Scholar
  7. 7.
    Volpe M, Rosei EA, Ambrosioni E, Cottone S, Cuspidi C, Borghi C, et al. 2012 2012 Consensus Document of the Italian Society of Hypertension (SIIA): strategies to improve blood pressure control in Italy: from global cardiovascular risk stratification to combination therapy. High Blood Press Cardiovasc Prev. 2013;20(1):45–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Volpe M, Rosei EA, Ambrosioni E, Cottone S, Cuspidi C, Borghi C, et al. Renal artery denervation for treating resistant hypertension: definition of the disease, patient selection and description of the procedure. High Blood Press Cardiovasc Prev. 2012;19(4):237–44.PubMedCrossRefGoogle Scholar
  9. 9.
    Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens. 2007;25(9):1751–62.PubMedCrossRefGoogle Scholar
  10. 10.
    Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009;27(11):2121–58.PubMedCrossRefGoogle Scholar
  11. 11.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72.PubMedCrossRefGoogle Scholar
  12. 12.
    Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013.Google Scholar
  13. 13.
    Rossi GP, Sechi LA, Giacchetti G, Ronconi V, Strazzullo P, Funder JW. Primary aldosteronism: cardiovascular, renal and metabolic implications. Trends Endocrinol Metab. 2008;19(3):88–90.Google Scholar
  14. 14.
    Rossi GP. A comprehensive review of the clinical aspects of primary aldosteronism. Nat Rev Endocrinol. 2011;7(8):485–95.Google Scholar
  15. 15.
    Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11):2293–300.Google Scholar
  16. 16.
    Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266–81.Google Scholar
  17. 17.
    Rossi GP, Barisa M, Belfiore A, Desideri G, Ferri C, Letizia C, et al. The aldosterone-renin ratio based on the plasma renin activity and the direct renin assay for diagnosing aldosterone-producing adenoma. J Hypertens 2010;28(9):1892–9.Google Scholar
  18. 18.
    Rossi GP, Seccia TM, Pessina AC. A diagnostic algorithm–the holy grail of primary aldosteronism. Nat Rev Endocrinol. 2011;7(12):697–9.Google Scholar
  19. 19.
    Rossi GP, Seccia TM, Palumbo G, Belfiore A, Bernini G, Caridi G, et al. Primary Aldosteronism in the Prevalence in hYpertension (PAPY) Study Investigators. Within-patient reproducibility of the aldosterone: renin ratio in primary aldosteronism. Hypertens. 2010;55(1):83–9.Google Scholar
  20. 20.
    Rossi GP, Barisa M, Allolio B, Auchus RJ, Amar L, Cohen D, et al. The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab. 2012;97(5):1606–14.Google Scholar
  21. 21.
    Rossi GP, Auchus RJ, Brown M, Lenders JW, Naruse M, Plouin PF, et al. An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertens. 2014;63(1):151–60.Google Scholar
  22. 22.
    Rossi GP, Cesari M, Cuspidi C, Maiolino G, Cicala MV, Bisogni V, et al. Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertens. 2013;62(1):62–9.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.Department of Medicine-DIMED, Internal Medicine 4University Hospital, University of PaduaPaduaItaly

Personalised recommendations