Case Report|Articles in Press, 104407

Difficult-to-Control Hypertension in a Primary Care Setting


      • 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.


      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.


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      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]


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