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Difficult-to-Control Hypertension in a Primary Care Setting

      Highlights

      • Primary aldosteronism (PA) is relatively common cause of difficult-to-control hypertension.
      • Unrecognized and untreated PA increases risk of cardiac and renal complications.
      • Initial workup of high-risk patients should include plasma aldosterone and renin levels.
      • Patients with elevated aldosterone and suppressed renin should be referred to specialty care.
      • Spironolactone is a drug of choice in treatment of bilateral adrenal hyperplasia.

      Abstract

      Primary aldosteronism is relatively common cause of secondary difficult-to-control hypertension. It can be cured with either surgery or targeted medical therapy. Unfortunately, it is rarely recognized by primary care providers. Undiagnosed and untreated, primary aldosteronism increases risk of cardiovascular and renal complications. Primary care nurse practitioners are well positioned to identify patients at risk and initiate diagnostic workup of primary aldosteronism to improve clinical outcomes of patients with poorly controlled hypertension.

      Keywords

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      References

        • Carey R.M.
        • Calhoun D.A.
        • Bakris G.L.
        • et al.
        Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association.
        Hypertension. 2018; 72: e53-e90https://doi.org/10.1161/HYP.0000000000000084
        • Benenson I.
        • Waldron F.
        • Bradshaw M.
        • Vitale T.
        Endocrine hypertension: a primer for primary care nurse practitioners.
        J Nurse Pract. 2019; 15: 782-786
        • Young Jr., W.F.
        Diagnosis and treatment of primary aldosteronism: practical clinical perspectives.
        J Intern Med. 2019; 285: 126-148https://doi.org/10.1111/joim.12831
        • Reincke M.
        • Bancos I.
        • Mulatero P.
        • Scholl U.I.
        • Stowasser M.
        • Williams T.A.
        Diagnosis and treatment of primary aldosteronism.
        Lancet Diabetes Endocrinol. 2021; 9: 876-892https://doi.org/10.1016/S2213-8587(21)00210-2
        • Tan J.E.
        • Wu D.
        • Stowasser M.
        A young man with severe hypertension.
        BMJ. 2018; 362: k2935https://doi.org/10.1136/bmj.k2935
        • Kline G.A.
        • Prebtani A.P.H.
        • Leung A.A.
        • Schiffrin E.L.
        Primary aldosteronism: a common cause of resistant hypertension.
        CMAJ. 2017; 189: 773-778https://doi.org/10.1503/cmaj.161486

      Biography

      Irina Benenson, DNP, FNP-C, is an associate professor, Advanced Nursing Division, Rutgers School of Nursing, Newark, NJ, and can be contacted at [email protected] .

      Biography

      Kimberly Buff Prado, DNP, APN, is a clinical assistant professor, Advanced Nursing Practice Division, Rutgers School of Nursing, Newark, NJ.