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The renin-angiotensin-aldosterone system effectively defends against volume depletion, but in most developed nations, dietary sodium is high, and aldosterone production should be suppressed. The syndrome of primary aldosteronism demonstrates the consequences of autonomous aldosterone production in a sodium-replete society. For many years, primary aldosteronism was thought to be an esoteric disorder only diagnosed by academicians at a handful of institutions worldwide. Conn, Biglieri, Bravo, and others characterized the syndrome and developed diagnostic strategies circa 1960–1980. Most clinicians, however, could not execute these algorithms, and management was unsatisfactory because of poor methods for localizing aldosterone production and limited options for medical management. Interest shifted to other mechanisms of hypertension, but during the last 20 years, the advent of commercial assays for renin and aldosterone, the broader use of adrenal vein sampling, and the development of selective aldosterone antagonists have rejuvenated interest in primary aldosteronism.1 Furthermore, end-organ damage is more severe in primary aldosteronism than in essential hypertension, and considerable evidence implicates the activation of mineralocorticoid receptors in these tissues as the mechanism.Implicit in this aldosterone renaissance is the importance of making the diagnosis of primary aldosteronism to allow implementation of tailored therapy. Proteinuria is more prevalent in patients with primary aldosteronism than in those with essential hypertension,2 and the excess proteinuria largely reverses after treatment with surgery or spironolactone.3 Thus, the benefits reaped from the detection of primary aldosteronism and the implementation of targeted therapy extend beyond optimal control of blood pressure.Another malady associated with primary aldosteronism is left ventricular (LV) hypertrophy (LVH).4 LVH is associated with adverse cardiovascular events and all-cause mortality.5 Therapy, which leads to regression of LVH in hypertensive subjects, reduces these risks.6 Despite the importance of LVH as a risk factor and the high prevalence of LVH in primary …

Will the Lessons From Primary Aldosteronism Change the Treatment of Hypertension and Left Ventricular Hypertrophy?