Hypertension (Dallas, Tex. : 1979)
September 17, 2026 · via Europe PMC
Evaluation of Current Screening Thresholds for the Detection of Primary Aldosteronism.
Voorhies KR, Bi C, Adeyemo MA, Dixit SB, Vaidya A, McPhaul MJ, Marcelli M.
AI summary — for doctors, generated from the abstract only
Applying the 2025 Endocrine Society screening thresholds classified half as many patients as positive for primary aldosteronism as broader permissive criteria, with most of the difference driven by modest aldosterone levels.
What was studied
A retrospective analysis of deidentified adults with plasma renin activity and plasma aldosterone concentration measured between January and August 2025 compared positivity under the updated Endocrine Society criteria against broader permissive criteria, and compared biochemical and clinical characteristics between groups.
Key findings
- Of 60,449 patients, 13.0% (n = 7,883) met Endocrine Society screening criteria versus 26.2% (n = 15,872) under permissive criteria.
- Among 8,006 patients (13.2%) who were permissive-positive but society-negative, 6,325 failed the society criteria solely because aldosterone fell between 5 and 7.5 ng/dL.
- A majority of that subgroup (55.2%) had a suppressed renin value; the specific renin threshold statistic is not fully captured in the abstract.
- The permissive-positive group was associated with hypertension (odds ratio 1.27; P = 0.0002) and hypokalemia (P = 0.0012), plus a further association reported with P = 0.004 whose variable is not fully captured in the abstract.
Clinical relevance
This retrospective laboratory-database comparison suggests current thresholds may miss milder renin-independent aldosterone production, but as the authors state the finding needs validation in cohorts with full clinical data before definitions change.
Who should care
Limitations
The analysis is retrospective and based on laboratory values without confirmatory testing, imaging or comprehensive clinical annotation, so true disease status in the discordant groups is unknown.
Where the aldosterone cutoff sits dramatically changes how many patients screen positive, and milder cases may be falling outside current criteria.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
In 2025, the Endocrine Society (ES) updated the guidelines for primary aldosteronism (PA), introducing more inclusive diagnostic criteria: plasma renin activity (PRA) ≤1 ng/mL per hour, plasma aldosterone concentration (PAC) ≥7.5 ng/dL by liquid chromatography-tandem mass spectrometry, and aldosterone-to-renin ratio >15. We compared PA positivity by comparing these updated criteria against broader permissive criteria (PRA 5 ng/dL, without an aldosterone-to-renin ratio requirement).
Methods
We retrospectively analyzed deidentified adults with PRA and PAC measurements between January and August 2025. Patients were categorized by ES versus permissive criteria. Biochemical and clinical characteristics were compared.
Results
Of 60 449 patients, 13.0% (n=7883) met ES screening criteria for PA versus 26.2% (n=15 872) by permissive criteria. Among the 8006 (13.2%) permissive-positive/ES-negative patients, 6325 did not meet ES criteria due to PAC 5 to 7.5 ng/dL, despite 55.2% having a PRA P=0.004), hypertension (odds ratio, 1.27; P=0.0002) and hypokalemia (KP=0.0012).
Conclusions
Current ES thresholds potentially exclude PA cases with a biochemical phenotype consistent with milder or earlier renin-independent aldosterone production. If validated in cohorts with comprehensive clinical data, the biochemical definition of PA may need to expand to include a greater proportion of individuals with renin-independent aldosterone production.
DOI
10.1161/hypertensionaha.126.27634
PMID
42751802
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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