Primary aldosteronism is currently considered to represent 5–13% of hypertension, yet fewer than 1% of patients with the disorder are ever diagnosed and treated. Current management of patients screened and confirmed positive for primary aldosteronism involves imaging, and with very few exceptions adrenal venous sampling to lateralize (or not) hyperaldosteronism. Unilateral disease is treated by adrenalectomy: bilateral disease by mineralocorticoid receptor antagonists and conventional antihypertensives as/if required. New therapeutic approaches include (i) routine screening on first presentation for hypertension; (ii) harmonisation of cut-offs for renin and aldosterone, plus use of 24-h urinary rather than spot plasma values for the latter; (iii) adoption of a dexamethasone enhanced seated saline suppression test for confirmation exclusion; (iv) enhanced imaging and steroid profiles as partial replacement for adrenal venous sampling; and finally (v), inclusion of low dose spironolactone in first-line therapy for hypertension.

目前认为原发性醛固酮增多症占高血压的5-13％，但曾经诊断和治疗过该疾病的患者不到1％。筛查并确认原发性醛固酮增多症阳性的患者的当前治疗涉及影像学检查，除少数例外，肾上腺静脉取样可使醛固酮增多症偏侧（或不偏侧）。单侧疾病通过肾上腺切除术治疗：双侧疾病通过盐皮质激素受体拮抗剂和常规降压药（如果需要）进行治疗。新的治疗方法包括：（i）首次出现高血压时的常规筛查；（ii）协调肾素和醛固酮的临界值，加上使用24小时尿液而非血浆血浆值；（iii）采用地塞米松增强坐位盐水抑制试验以确认排除；（iv）增强成像和类固醇特征，以部分替代肾上腺静脉采样；最后（v），将低剂量螺内酯纳入高血压的一线治疗。