Primary Aldosteronism: What It Is and How to Handle It
Ever wonder why some people have stubborn high blood pressure even after lifestyle changes? One hidden reason could be primary aldosteronism, a condition where the adrenal glands make too much aldosterone. Aldosterone is a hormone that tells your kidneys to hold onto salt and water, which pushes up blood pressure. When the body overproduces it, you can end up with resistant hypertension, low potassium, and a higher risk of heart problems.
Why It Happens
Most cases come from a small tumor called an aldosterone‑producing adenoma or from both adrenal glands being overactive (bilateral hyperplasia). The tumor or hyperactive tissue doesn’t need any external signal to release aldosterone, so the hormone keeps flowing nonstop. This excess makes your body retain sodium, lose potassium, and pull more fluid into the bloodstream – the perfect recipe for high blood pressure.
Risk factors include a family history of early‑onset hypertension, certain genetic mutations, or a personal history of unexplained low potassium levels. If you’ve been told your blood pressure is high despite a healthy diet and exercise, it’s worth asking your doctor about screening for primary aldosteronism.
How to Diagnose and Treat
The first step is a simple blood test to check aldosterone and renin levels. A high aldosterone‑to‑renin ratio often signals the condition. If that looks suspicious, doctors may do a confirmatory test, like a saline infusion or a captopril challenge, to see how the hormone reacts. Imaging scans (CT or MRI) can then pinpoint whether a tumor is present.
Treatment depends on the cause. If a single adenoma is found, minimally invasive surgery called adrenalectomy can cure the problem in most cases. For bilateral hyperplasia, medication is the go‑to option. Drugs called mineralocorticoid receptor antagonists (e.g., spironolactone or eplerenone) block aldosterone’s effects, helping lower blood pressure and restore potassium levels.
Even after treatment, regular follow‑up is key. Blood pressure should be monitored, and potassium levels checked periodically. Lifestyle tweaks like reducing salty foods, staying active, and managing stress still play a role in keeping your heart healthy.
Bottom line: primary aldosteronism is a treatable cause of high blood pressure. If you’ve got stubborn hypertension or low potassium, bring it up with your healthcare provider. Early detection and proper management can prevent long‑term complications and get your blood pressure back under control.
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