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Primary aldosteronism

Don't miss primary aldosteronism in your patients with hypertension

~120M people are hypertensive in the US1

Up to 30% of people with hypertension in the US may have primary aldosteronism2

<1% of patients with hypertension are screened for primary aldosteronism3

Primary aldosteronism (PA) is a condition that can lead to serious health complications if patients aren’t screened and diagnosed.

PA is underrecognized, resulting in a screening rate of <1% of all hypertensive patients and only 1.6% of patients with resistant hypertension. PA is also the most common cause of secondary hypertension.3

Patients with untreated PA are at a disproportionately higher risk of cardiovascular, kidney, and metabolic disease when compared to patients with essential hypertension.

These conditions include but are not limited to heart failure, kidney disease, stroke, atrial fibrillation (AF), myocardial infarction, type 2 diabetes mellitus (T2DM), and sleep apnea.4,5

2025 Endocrine Society clinical practice guidelines on primary aldosteronism suggest that all patients with hypertension be screened for PA.2

See guidelines

Looking for more insights on primary aldosteronism and advances in diagnosis?

Listen to our Healthier World podcast episode hosted by Maeson Latsko, PhD, Clinical and Education Specialist at Quest Diagnostics® Cardiometabolic Center of ExcellenceTM at Cleveland Heartlab®, and featuring Dr Sanjay Dixit and Dr Marco Marcelli, board-certified endocrinologists and medical directors with Quest Diagnostics.

Listen now

Quest's solution for primary aldosteronism screening

An ARR >15 confirms the presence of PA. To calculate the ARR, divide the Aldosterone result by the Plasma Renin Activity result.

Considerations prior to testing6

  • Assess potassium levels if not performed recently; low potassium may lead to a false positive for low aldosterone
  • Patient should cease mineralocorticoid receptor antagonist (MRA) or and epithelial sodium-channel (ENaC) inhibitor use for 4 weeks prior to avoid interference with the renin-independent pathway

Clinical practice guidelines for PA diagnosis

  • If the result of Plasma Renin Activity (PRA) is suppressed (ie, ≤1 ng/mL/min)
  • And, the result of Aldosterone is ≥7.5 ng/mL
  • And, the Aldosterone Renin Ratio (ARR) value is >15

Then, the patient meets criteria for primary aldosteronism based on the 2025 Endocrine Society clinical practice guidelines.2

Plasma Renin Activity (PRA) Reflex to Aldosterone, LC/MS/MS

Plasma Renin Activity,

LC/MS/MS

Aldosterone, LC/MS/MS

 

Potassium, Serum

 

Read more about primary aldosteronism and Quest's screening solutions

Download brochure
PA brochure thumbnail

 

References 

  1. CDC. Division for Heart Disease and Stroke Prevention. Million Hearts®. Hypertension cascade: hypertension prevalence, treatment, and control estimates among US adults aged 18 years and older applying the criteria from the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2017–2020. Last reviewed May 12, 2023. Accessed September 3, 2024. https://millionhearts.hhs.gov/data-eports/hypertensionprevalence.html
  2. Adler GK, Stowasser M, Correa RR, et al. Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline. Endocrine Society. July 14, 2025. Accessed August 7, 2025. https://www.endocrine.org/clinical-practice-guidelines/primary-aldosteronism-2
  3. Funder JW, Carey RM, Fardella C, 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):3266–3281. doi: 10.1210/jc.2008-0104
  4. Cleveland Clinic. Primary aldosteronism (Conn’s syndrome). Last reviewed July 22, 2024. Accessed September 3, 2024. https://.my.clevelandclinic.org/health/diseases/21061-conns-syndrome 
  5. Hung A, Ahmed S, Gupta A, et al. Performance of the aldosterone to renin ratio as a screening test for primary aldosteronism. J Clin Endocrinol Metab. 2021;106(8):2423–2435. doi: 10.1210/clinem/dgab348
  6. Funder JW, Carey RM, Fardella C, 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):3266-3281. doi: 10.1210/jc.2008-0104

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