Primary aldosteronism (PA) is the most common cause of secondary hypertension and is associated with increased morbidity and mortality when compared to blood pressure-matched cases of primary hypertension. Current limitations in patient care stem from delayed recognition of the condition, limited access to key diagnostic procedures, and lack of a definitive therapy option for non-surgical candidates. However, several recent advances have the potential to address these barriers to optimal care. From a diagnostic perspective, machine learning algorithms have shown promise in the prediction of PA subtypes, while the development of non-invasive alternatives to adrenal vein sampling (including molecular PET imaging) has made accurate localisation of functioning adrenal nodules possible. In parallel, more selective approaches to targeting the causative aldosterone-producing adrenal adenoma/nodule (APA/APN) have emerged with the advent of partial adrenalectomy or precision ablation. Additionally, the development of novel pharmacological agents may help to mitigate off-target effects of aldosterone and improve clinical efficacy and outcomes. Here, we consider how each of these innovations might change our approach to the patient with PA, to allow more tailored investigation and treatment plans, with corresponding improvement in clinical outcomes and resource utilisation, for this highly prevalent disorder.

中文翻译：

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治疗原发性醛固酮增多症诱发的高血压：新方法和未来展望。

原发性醛固酮增多症 (PA) 是继发性高血压的最常见原因，与血压匹配的原发性高血压病例相比，其发病率和死亡率增加。目前患者护理的局限性源于对病情的延迟认识、关键诊断程序的获取有限以及非手术候选者缺乏明确的治疗选择。然而，最近的一些进展有可能解决这些最佳护理的障碍。从诊断的角度来看，机器学习算法在预测 PA 亚型方面显示出了希望，而肾上腺静脉采样的非侵入性替代方案（包括分子 PET 成像）的开发使得功能性肾上腺结节的准确定位成为可能。与此同时，随着肾上腺部分切除术或精确消融的出现，针对产生醛固酮的肾上腺腺瘤/结节（APA/APN）的更具选择性的方法也出现了。此外，新型药物的开发可能有助于减轻醛固酮的脱靶效应并改善临床疗效和结果。在这里，我们考虑每项创新如何改变我们对 PA 患者的治疗方法，以便针对这种高度流行的疾病制定更量身定制的调查和治疗计划，并相应改善临床结果和资源利用。