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CLINICAL STATEMENTS AND GUIDELINES

September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e136

Figure 5. Screening for Features Suggesting Secondary Hypertension. Refer to Table 10 for additional tests for secondary hypertension. HTN indicates hypertension; and TOD, target organ damage (eg, cerebrovascular disease, hypertensive retinopathy, left ventricular hypertrophy, left ventricular dysfunction, heart failure, coronary artery disease, chronic kidney disease, albuminuria, peripheral artery disease). Modified with permission from Whelton et al.14 Copyright 2018 American College of Cardiology Foundation and American Heart Association, Inc.

1 C-LD 3 In adults with an indication for screening for primary

aldosteronism, use of plasma aldosterone, renin activ­ ity, and the plasma aldosterone to renin activity ratio is recommended for initial screening to assess if there is biochemical evidence of primary aldosteronism.1–3

1 C-EO 4 In adults with an indication for screening for pri­

mary aldosteronism, it is recommended to continue most antihypertensive medications (other than min­ eralocorticoid receptor antagonists [MRAs]) prior to initial screening to minimize barriers to or delays in screening. 1 C-EO 5 In adults with hypertension and a positive screening

test for primary aldosteronism or continued suspicion for primary aldosteronism based on suppressed plasma renin or disproportionate target organ damage, referral to a hypertension specialist or endocrinologist is recommended for further evaluation and treatment.

Synopsis

Primary aldosteronism is defined as a group of disorders in which aldosterone production is inappropriately high

Recommendations for Primary Aldosteronism (Continued) COR LOE Recommendations Recommendations for Primary Aldosteronism (Continued)

COR LOE Recommendations

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