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Primary aldosteronism

Don't miss primary aldosteronism in your patients with hypertension

120M US adults are hypertensive1

Up to 14% of people with hypertension in primary care settings have primary aldosteronism2

Up to 30% of people with hypertension seen by specialists have primary aldosteronism2

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

PA is more common than previously recognized

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

Despite its prevalence, PA remains significantly underdiagnosed—particularly in patients with resistant or difficult-to-control hypertension. Identifying PA enables targeted therapy and, when appropriate, timely nephrology referral—helping address the underlying cause.

Compared to primary hypertension, untreated PA is associated with a disproportionately higher risk of cardiovascular, kidney, and metabolic complications.4,5

Recent alignment of major society guidelines supports more broad screening for PA

2025 American Heart Association (AHA) and American College of Cardiology (ACC) guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults recommend screening all patients with resistant hypertension6

2025 Endocrine Society clinical practice guidelines on primary aldosteronism suggest that all patients with hypertension be screened2

Looking for more insights on primary aldosteronism screening?

Read our Provider Insights article for more details on updated guidelines and testing strategies.

Read the article

Simplified PA screening solution from Quest Diagnostics

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

Simplify screening and get clearer answers without added complexity

  • Requires only 1 blood draw
  • Automatically reflexes to perform aldosterone test only when PRA result indicates suppressed renin
  • Does not require discontinuation of most antihypertensive medications prior to testing*
  • Provides more information up front to guide treatment decisions

*Patient should cease mineralocorticoid receptor antagonist (MRA) or epithelial sodium channel (ENaC) use for 4 weeks prior to avoidinterference with the
Renin-Angiotensin-Aldosterone System (RAAS)7

Clinical practice guidelines for PA diagnosis

  • If the result of Plasma Renin Activity (PRA) is suppressed (ie, ≤1 ng/mL/h), 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

 

Aldosterone/Plasma Renin

Activity Ratio, 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. American College of Cardiology. New ACC/AHA guideline addresses prevention, detection, evaluation and management of high blood pressure. August 14, 2025. Accessed April 10, 2026. https://www.acc.org/Latest-in-Cardiology/Journal-Scans/2025/08/14/15/36/New-ACC-AHA-Guideline-Addresses-Prevention-Detection-Evaluationand-Management-of-HBP
  7. 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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