Understanding Primary Aldosteronism

If you have struggled to control your high blood pressure despite taking multiple medications, you may have been told you have “essential hypertension”—a term doctors use when the cause is unknown. However, for many people, the cause is very specific: a condition called Primary Aldosteronism (PA), also known as Conn’s Syndrome.

Primary Aldosteronism occurs when your adrenal glands (two small glands located on top of your kidneys) produce too much of a hormone called aldosterone ^[1]. This hormone regulates the balance of salt and water in your body. When you have too much of it, your body holds onto excess salt and water, which drives up your blood pressure and can cause damage to your heart, kidneys, and blood vessels ^[2][3].

A Hidden Epidemic

For decades, PA was taught in medical schools as a rare condition that only affected about 1% of people with high blood pressure. We now know this is incorrect. Research shows that PA is the most common cause of “secondary” hypertension (high blood pressure caused by a specific, identifiable condition) ^[4].

• General Hypertension: It is estimated that 5% to 13% of all people with high blood pressure actually have PA ^[4][5].
• Resistant Hypertension: For those whose blood pressure remains high despite taking three or more medications, the rate jumps to nearly 20% ^[6][7].

Shifting the Paradigm: From “Rare” to a “Spectrum”

Medical understanding of PA has changed significantly in recent years. Doctors used to view PA as a “binary” disease—you either had a large tumor on one adrenal gland or you didn’t.

Today, experts recognize PA as a continuum of autonomous aldosterone production ^[8]. This means the disease exists on a spectrum ^[9]:

• Mild/Subclinical: Your body produces slightly too much aldosterone, which may not cause severe high blood pressure yet but can still begin to strain your cardiovascular system ^[10].
• Overt PA: The hormone production is so high that it causes severe, difficult-to-treat hypertension and may lead to low potassium levels ^[11].

Why is it Often Overlooked?

Many primary care doctors do not routinely screen for PA because of two common “clinical pitfalls”:

1. The Potassium Myth: In the past, doctors only looked for PA if a patient had low potassium (hypokalemia). However, we now know that most people with PA actually have normal potassium levels ^[12].
2. The “Essential” Label: Because PA is so common, it is often misdiagnosed as standard “essential” hypertension ^[1]. Doctors may simply keep adding more generic blood pressure medications rather than testing for the underlying hormonal cause ^[13].

Three Stabilizing Facts

If you are concerned you might have PA, it is important to keep these facts in mind:

• It is a distinct disease: PA is not your fault. It is not caused by poor diet or lack of exercise; it is a physical, hormonal imbalance that requires a specific diagnosis ^[1].
• It is highly treatable (and sometimes curable): If the excess hormone is coming from only one adrenal gland, the condition can often be cured with a minimally invasive surgery ^[14]. If it affects both glands, it can be managed very effectively with specific medications called mineralocorticoid receptor antagonists (MRAs) ^[15].
• You deserve a targeted approach: Standard blood pressure drugs often fail to protect the heart and kidneys of PA patients because they don’t block the toxic effects of excess aldosterone ^[15]. Getting the right diagnosis allows for the right protection ^[16].

In This Guide

Explore the pages below to understand your diagnosis, prepare for testing, and explore treatment options.