Diagnosis of primary aldosteronism and the algorithm of interaction between a cardiologist and an endocrinologist from the position of a cardiologist

Abstract

Primary aldosteronism is one of the most common causes of secondary arterial hypertension. The probability of its detection is especially high in patients with hypertension resistant to ongoing therapy. The purpose of the review is to analyze the causes of underdiagnosis of primary aldosteronism based on the data of modern publications, discuss the main trends in approaches to identifying this pathological condition, and justify the need for closer interaction between all specialists involved in the process of providing medical care to patients of this category. The review provides data on the groups of patients in whom it is most helpful to screen primary aldosteronism, and the frequency of this screening in real practice. The advantages and disadvantages of using various criteria for the primary diagnosis of primary aldosteronism are analyzed. The need for common approaches to the methodology of examination and management of patients with suspected primary aldosteronism is discussed for general practitioners, therapists, cardiologists, organizers of laboratory services and endocrinologists. The negative consequences of long-term exposure to elevated levels of aldosterone on the cardiovascular system of patients with primary aldosteronism, their cardiovascular prognosis are analyzed. The necessity of the most thorough identification of patients with primary aldosteronism subject to surgical treatment is substantiated. Criteria for the effectiveness of drug therapy in case of non-indication or impossibility of performing surgical intervention are given.