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CLINICAL STATEMENTS AND GUIDELINES

September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e192

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3.2.3 Secondary Forms of Hypertension

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of primary aldosteronism in 1125 hypertensive patients. J Am Coll Cardiol. 2006;48:2293–2300. 2.	 Xu Z, Yang J, Hu J, et al. Primary aldosteronism in patients in China with recently detected hypertension. J Am Coll Cardiol. 2020;75:1913–1922. 3.	 Brown JM, Siddiqui M, Calhoun DA, et al. The unrecognized preva­ lence of primary aldosteronism: a cross-sectional study. Ann Intern Med. 2020;173:10–20. 4.	 Brown JM, Robinson-Cohen C, Luque-Fernandez MA, et al. The spectrum of subclinical primary aldosteronism and incident hypertension: a cohort study. Ann Intern Med. 2017;167:630–641. 5.	 Jinchai J, Khamsai S, Chattakul P, et al. How common is obstructive sleep apnea in young hypertensive patients? Intern Emerg Med. 2020;15:1005– 1010. 6.	 Pedrosa RP, Drager LF, Gonzaga CC, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58:811–817. 7.	 Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breath­ ing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283:1829–1836. 8.	 Hundemer GL, Agharazii M, Madore F, et al. Subclinical primary aldosteron­ ism and cardiovascular health: a population-based cohort study. Circulation. 2024;149:124–134. 9.	 Monticone S, Burrello J, Tizzani D, et al. Prevalence and clinical manifesta­ tions of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol. 2017;69:1811–1820. 10.	 Bhalla V, Textor SC, Beckman JA, et al. Revascularization for renovascular disease: a scientific statement from the American Heart Association. Hyper­ tension. 2022;79:e128-e143. 11.	 Vitarello JA, Fitzgerald CJ, Cluett JL, et al. Prevalence of medications that may raise blood pressure among adults with hypertension in the United States. JAMA Intern Med. 2022;182:90–93. 12.	 MacIntyre IM, Turtle EJ, Farrah TE, et al. Regular acetaminophen use and blood pressure in people with hypertension: the PATH-BP trial. Circulation. 2022;145:416–423. 13.	 Patel KA, Bhatt MH, Hirani RV, et al. Assessment of potential drug-drug in­ teractions among outpatients in a tertiary care hospital: focusing on the role of P-glycoprotein and CYP3A4 (retrospective observational study). Heliyon. 2022;8:e11278. 14.	 Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a re­ port of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–1324. 15.	 Pivetta B, Chen L, Nagappa M, et al. Use and performance of the STOP- Bang questionnaire for obstructive sleep apnea screening across geo­ graphic regions: a systematic review and meta-analysis. JAMA Netw Open. 2021;4:e211009. 16.	 Bernhardt L, Brady EM, Freeman SC, et al. Diagnostic accuracy of screening questionnaires for obstructive sleep apnoea in adults in different clinical co­ horts: a systematic review and meta-analysis. Sleep Breath. 2022;26:1053– 1078. 17.	 Delgado C, Baweja M, Crews DC, et al. A unifying approach for GFR

estimation: recommendations of the NKF-ASN Task Force on reassess­ ing the inclusion of race in diagnosing kidney disease. Am J Kidney Dis. 2022;79:268–288.e261. 18 Fu EL, Carrero JJ, Sang Y, et al. Association of low glomerular filtration

rate with adverse outcomes at older age in a large population with routinely measured cystatin C. Ann Intern Med 2024;177:269–279. 19.	 Funder JW, Carey RM, Mantero F, et al. The management of primary aldo­ steronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101:1889–1916. 20.	 Young WF Jr, Calhoun DA, Lenders JWM, et al. Screening for endocrine hypertension: an Endocrine Society scientific statement. Endocrine Rev. 2017;38:103–122. 21.	 Leung AA, Pasieka JL, Hyrcza MD, et al. Epidemiology of pheochromocy­ toma and paraganglioma: population-based cohort study. Eur J Endocrinol. 2021;184:19–28. 22.	 Ebbehoj A, Stochholm K, Jacobsen SF, et al. Incidence and clinical presen­ tation of pheochromocytoma and sympathetic paraganglioma: a populationbased study. J Clin Endocrinol Metab. 2021;106:e2251-e2261. 23.	 Isselbacher EM, Preventza O, Black JH 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a re­ port of the American Heart Association/American College of Cardi­ ology Joint Committee on Clinical Practice Guidelines. Circulation. 2022;146:e334–e482. 24.	 Fallo F, Di Dalmazi G, Beuschlein F, et al. Diagnosis and management of hypertension in patients with Cushing's syndrome: a position statement and consensus of the Working Group on Endocrine Hypertension of the Euro­ pean Society of Hypertension. J Hypertens. 2022;40:2085–2101. 25.	 Fleseriu M, Biller BMK, Freda PU, et al. A Pituitary Society update to acro­ megaly management guidelines. Pituitary. 2021;24:1–13. 26.	 Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596–e646. 27.	 Roerecke M, Kaczorowski J, Tobe SW, et al. The effect of a reduction in alco­ hol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health. 2017;2:e108-e120. 28.	 Teramoto M, Yamagishi K, Muraki I, et al. Coffee and green tea consumption and cardiovascular disease mortality among people with and without hyper­ tension. J Am Heart Assoc 2023;12:e026477. 29.	 Penninkilampi R, Eslick EM, Eslick GD. The association between consistent licorice ingestion, hypertension and hypokalaemia: a systematic review and meta-analysis. J Hum Hypertens. 2017;31:699–707. 30.	 Vongpatanasin W, Kario K, Atlas SA, et al. Central sympatholytic drugs. J Clin Hypertens (Greenwich). 2011;13:658–661. 31.	 Luther JM, Dominiczak AF, Jennings GLR, et al. Paroxysmal hypertension associated with presyncope. Hypertension. 2019;74:718–725. 32.	 Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disor­ der in children and adolescents. Pediatrics. 2019;144:. 33.	 Parks KA, Parks CG, Yost JP, et al. Acute blood pressure changes associ­ ated with antipsychotic administration to psychiatric inpatients. Prim Care Companion CNS Disord. 2018;20:18m02299. 34.	 Li XQ, Tang XR, Li LL. Antipsychotics cardiotoxicity: what's known and what's next. World J Psychiatry. 2021;11:736–753. 35.	 Cameron NA, Blyler CA, Bello NA. Oral contraceptive pills and hyperten­ sion: a review of current evidence and recommendations. Hypertension. 2023;80:924–935. 36.	 Aggarwal R, Heller G, Hillman DW, et al. PRESTO: a phase III, open-label

study of intensification of androgen blockade in patients with high-risk bio­ chemically relapsed castration-sensitive prostate cancer (AFT-19). J Clin Oncol. 2024;42:1114–1123.

3.2.3.1 Primary Aldosteronism

1 Montori VM, Young WF Jr. Use of plasma aldosterone concentration-to-

plasma renin activity ratio as a screening test for primary aldosteronism. A systematic review of the literature. Endocrinol Metab Clin North Am. 2002;31:619–632, xi. 2.	 Maiolino G, Rossitto G, Bisogni V, et al. Quantitative value of aldosteronerenin ratio for detection of aldosterone-producing adenoma: the Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) study. J Am Heart Assoc. 2017;6:e005574. 3.	 Brown JM, Siddiqui M, Calhoun DA, et al. The unrecognized preva­ lence of primary aldosteronism: a cross-sectional study. Ann Intern Med. 2020;173:10–20. 4.	 Funder JW, Carey RM, Mantero F, et al. The management of primary aldo­

steronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101:1889–1916.

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