Cor Vasa 2026, 68(1):66-72

(Impact of Methodology on the Estimated Prevalence of Primary Hyperaldosteronism in Apparently Resistant Hypertension)

Tomáš Kvapila, Eva Kociánováa, Zdeněk Ramíkb, Jan Olšra, Jan Váchaa, Libor Jelínekc, Jan Václavíkb
a I. interní klinika - kardiologická, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc, Česká republika
b Klinika interního lékařství a kardiologie, Lékařská fakulta Ostravské univerzity a Fakultní nemocnice Ostrava, Ostrava, Česká republika
c Klinika tělovýchovného lékařství a kardiovaskulární rehabilitace, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc, Česká republika

Objective: The aim of this review is to summarize current knowledge on the prevalence of primary hyperaldosteronism (PHA) in patients with apparently resistant hypertension (aRH) and to critically analyze the methodological factors influencing the estimation of this prevalence.

Methods: A review of the available literature was conducted, focusing on studies assessing the prevalence of PHA in patients with resistant hypertension. Methodological differences between studies were analyzed, including definitions of resistant hypertension, thresholds for the aldosterone-renin ratio (ARR), use of confirmatory tests, management of interfering antihypertensive medications, and approaches to ruling out white-coat effect and other secondary causes of hypertension.

Results: The analyzed studies show considerable variability in the reported prevalence of PHA (7.1-29.1%), primarily due to methodological heterogeneity. The highest prevalence was observed in studies with rigorous exclusion of pseudoresistance and other secondary causes of hypertension. Key sources of variability included differences in the definition of resistant hypertension, ARR threshold values, use of confirmatory tests (e.g., intravenous saline suppression test, fludrocortisone suppression test), and approaches to pharmacological preparation.

Conclusions: Primary hyperaldosteronism is a frequent and clinically important cause of aRH. To obtain more reliable estimates of the true prevalence of PHA and improve diagnostic and therapeutic management, it is essential to harmonize and standardize diagnostic protocols-particularly regarding the definition of resistant hypertension, screening and confirmatory methods, and the handling of antihypertensive treatment during diagnostic work-up.

Keywords: Aldosterone-renin ratio, Primary hyperaldosteronism, Resistant hypertension, Secondary hypertension

Received: July 18, 2025; Revised: August 26, 2025; Accepted: August 30, 2025; Prepublished online: June 2, 2012; Published: March 15, 2026  Show citation

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Kvapil T, Kociánová E, Ramík Z, Olšr J, Vácha J, Jelínek L, Václavík J. (Impact of Methodology on the Estimated Prevalence of Primary Hyperaldosteronism in Apparently Resistant Hypertension). Cor Vasa. 2026;68(1):66-72.
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    References

    1. Käyser SC, Deinum J, De Grauw WJ, et al. Prevalence of primary aldosteronism in primary care: a cross-sectional study. Br J Gen Pract 2018;68:e114-e122.
    2. Calhoun DA, Nishizaka MK, Zaman MA, et al. Hyperaldosteronism Among Black and White Subjects With Resistant Hypertension. Hypertension 2002;40:892-896.
    3. Douma S, Petidis K, Doumas M, et al. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet 2008;371:1921-1926.
    4. Sang X, Jiang Y, Wang W, et al. Prevalence of and risk factors for primary aldosteronism among patients with resistant hypertension in China. J Hypertens 2013;31:1465-1472.
    5. Parasiliti-Caprino M, Lopez C, Prencipe N, et al. Prevalence of primary aldosteronism and association with cardiovascular complications in patients with resistant and refractory hypertension. J Hypertens 2020;38:1841-1848.
    6. Chernova I, Krishnan N. Resistant Hypertension Updated Guidelines. Curr Cardiol Rep 2019;21:117.
    7. McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J 2024;45:3912-4018.
    8. Florczak E, Prejbisz A, Szwench-Pietrasz E, et al. Clinical characteristics of patients with resistant hypertension: the RESIST-POL study. J Hum Hypertens 2013;27:678-685.
    9. Štrauch B, Zelinka T, Hampf M, et al. Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region. J Hum Hypertens 2003;17:349-352.
    10. Umpierrez GE, Cantey P, Smiley D, et al. Primary Aldosteronism in Diabetic Subjects With Resistant Hypertension. Diabetes Care 2007;30:1699-1703.
    11. Martell N, Rodriguez-Cerrillo M, Grobbee DE, et al. High Prevalence of Secondary Hypertension and Insulin Resistance in Patients with Refractory Hypertension. Blood Press 2003;12:149-154.
    12. Gallay BJ, Ahmad S, Xu L, et al. Screening for primary aldosteronism without discontinuing hypertensive medications: Plasma aldosterone-renin ratio. Am J Kidney Dis 2001;37:699-705.
    13. Eide IK, Torjesen PA, Drolsum A, et al. Low-renin status in therapy-resistant hypertension: a clue to efficient treatment. J Hypertens 2004;22:2217-2226.
    14. Muxfeldt ES, Margallo VS, Guimaraes GM, Salles GF. Prevalence and Associated Factors of Obstructive Sleep Apnea in Patients with Resistant Hypertension. Am J Hypertens 2014;27:1069-1078.
    15. Samnani S, Cenzer I, Kline GA, et al. Time to Benefit of Surgery vs Targeted Medical Therapy for Patients With Primary Aldosteronism: A Meta-analysis. J Clin Endocrinol Metab 2024;109:e1280-e1289.
    16. Nikrýnová Nguyen TMP. Registr primárního aldosteronismu v České republice. Hypertenze a kardiovaskulární prevence 2024;14:43-45.
    17. Zelinka T, Widimský J, Ceral J, Filipovský J. Jak postupovat při podezření na sekundární arteriální hypertenzi. Vnitř Lék 2016;62:740-745.

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