Only 1 in 100 Hypertension Patients Screened for a Treatable Hidden Cause
A real-world study finds 8.7% of screened hypertension patients have primary aldosteronism — yet fewer than 1% ever get tested.
Summary
Primary aldosteronism is a hormonal condition where the adrenal glands overproduce aldosterone, causing hard-to-control high blood pressure. It's considered common but massively underdiagnosed. A new real-world study of 2.5 million adults with hypertension found that fewer than 1% were ever screened for it — yet among those who were, nearly 1 in 12 tested positive. This matters because primary aldosteronism carries dramatically higher risks of stroke, cardiovascular death, and all-cause mortality if left untreated. Specific treatments — including the drug spironolactone or surgery — can directly address the root cause, unlike standard blood pressure medications. Endocrine Society guidelines already recommend universal screening, but most clinicians aren't following them.
Detailed Summary
Primary aldosteronism is a hormonal disorder in which the adrenal glands produce excess aldosterone, driving up blood pressure in a way that standard antihypertensives don't fully address. Despite being widely recognized as a common and underdiagnosed condition, a striking new study shows how rarely patients are actually evaluated for it in clinical practice.
Researchers analyzed data from over 2.5 million adults with newly diagnosed hypertension drawn from a large U.S. claims and electronic health record database spanning 2011 to 2023. Of this group, only 18,787 individuals — just 0.76% — were ever screened for primary aldosteronism. Among the 9,414 with full biochemical data, 819 screened positive, representing an 8.7% positive rate. Presented at ENDO 2026, these findings suggest that millions of hypertension patients may be walking around with an undiagnosed, treatable hormonal cause driving their condition.
The stakes are high. A 2023 Swedish study linked primary aldosteronism to a 23% higher risk of all-cause mortality, a 57% higher risk of cardiovascular death, and an 85% higher risk of stroke compared to the general population. Untreated patients faced more than double the mortality risk. A 2020 meta-analysis similarly found elevated 3-year mortality in this group versus those with standard essential hypertension.
Screening is straightforward — a blood test measuring aldosterone and renin levels. Predictors of a positive screen included older age, Asian or Black race, and low potassium (hypokalemia). First-line treatment is spironolactone, an affordable mineralocorticoid receptor antagonist, or surgery when appropriate. Both approaches target the root hormonal dysfunction rather than just managing blood pressure symptoms.
The core implication is clear: if you have high blood pressure that is difficult to control, asking your doctor about aldosterone and renin testing could uncover a treatable underlying cause that most patients never get the chance to address.
Key Findings
- Only 0.76% of 2.5 million hypertension patients were screened for primary aldosteronism in real-world practice.
- 8.7% of screened patients tested positive — roughly 1 in 12 — indicating significant missed diagnoses at scale.
- Untreated primary aldosteronism raises stroke risk by 85% and cardiovascular death risk by 57% vs. general population.
- Older age, Asian or Black race, and low potassium are key predictors of a positive aldosteronism screen.
- Spironolactone and surgery offer targeted treatment that standard blood pressure drugs cannot replicate.
Methodology
This is a meeting coverage news report from MedPage Today based on a retrospective cohort study presented at ENDO 2026. The study used Optum Labs Data Warehouse, a large validated U.S. claims and EHR database covering 2011–2023, lending reasonable real-world credibility. The findings are preliminary conference data and have not yet been published in a peer-reviewed journal.
Study Limitations
Data are from a conference presentation and not yet peer-reviewed, so methodology details are limited. Retrospective claims-based data may introduce coding errors or selection bias in who received screening. The positive screen definition used may differ across clinical settings, and confirmation rates beyond initial screening were not reported.
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