New Delhi: A large number of hypertension patients may unknowingly suffer from primary aldosteronism (PA) — a common but underdiagnosed hormonal disorder that significantly increases the risk of heart disease, stroke and kidney damage, a new study by AIIMS Delhi has revealed.While most hypertension cases are classified as ‘primary’ or ‘essential’ hypertension, meaning they have no clearly identifiable cause, some result from secondary hypertension, which stems from identifiable medical conditions like kidney disease, thyroid disorders or obesity. Among these, PA is considered the most common cause.Primary aldosteronism occurs when the adrenal glands produce excessive aldosterone, a hormone responsible for regulating blood pressure by controlling sodium and potassium levels. Overproduction of aldosterone leads to sodium retention, potassium loss and persistent high blood pressure which, over time, can damage the heart and other vital organs.In the study conducted at the medicine and endocrinology OPD of AIIMS, 492 adults with essential hypertension were screened for PA. Initial tests showed that 91 individuals (18.5%) were likely to have the condition. Of these, 59 patients consented to further testing, and 37 were confirmed to have PA, accounting for a little over 8% of the total participants. The patients involved in the study were aged 18 and above, with a median duration of hypertension of five years.Prof Rajesh Khadgawat, senior author of the study from the Department of Endocrinology and Metabolism at AIIMS, said the findings clearly indicate that PA is a common cause of hypertension in India and stressed that all hypertensive patients should ideally be screened for it. New research has also stated that screening should be done among all hypertension patients.The researchers emphasised the importance of early diagnosis, warning that prolonged exposure to elevated aldosterone levels can cause irreversible damage to the heart, kidneys and blood vessels, leading to serious cardiovascular events.“Early diagnosis and targeted treatment of PA are crucial. It can significantly improve blood pressure control and reduce long-term complications,” the study noted.Dr Manaswini Bhatt, assistant professor and co-author of the study, pointed out that earlier, PA was thought to primarily affect individuals under 40 years with early-onset hypertension, but the current research challenges that notion. “This study shows PA can occur in any adult over 18 years, regardless of age,” she said.According to AIIMS doctors, diagnosis begins with measuring plasma aldosterone and direct renin concentration, which is used to calculate the aldosterone renin ratio (ARR) — a blood test that evaluates the balance between two key hormones. If the ARR is elevated, it is followed by confirmatory testing, such as the saline infusion test (SIT), as recommended by the Endocrine Society guidelines.Treatment for PA depends on whether one or both adrenal glands are overproducing aldosterone. In unilateral cases, surgical removal of the overactive adrenal gland (adrenalectomy) is often the preferred option. In bilateral cases, or when surgery is not feasible, patients are managed with medications that help control blood pressure and correct electrolyte imbalances.Dr Bhatt said the study highlights the urgent need to raise awareness and strengthen diagnostic practices to prevent avoidable organ damage and cardiovascular complications in patients with undiagnosed PA.
