Title of project

Primary aldosteronism and secondary hypertension: Challenging and improving current clinical guidelines

Abstract

Primary aldosteronism (PA) is the most common form of secondary hypertension, affecting 4-6% of individuals with hypertension in primary care. PA causes significant cardiovascular morbidity and mortality, but outcomes can be improved with specific medical treatment and, in about half of patients, surgically cured. Despite its prevalence and consequences, the diagnosis and management of PA remains suboptimal due to several key challenges: 1) limited data on risk factors for PA, 2) low guideline adherence due to the complicated screening strategy, and 3) technical and diagnostic issues with adrenal vein sampling (AVS) for determining surgical candidates. This postdoctoral project seeks to address these three challenges in current clinical guidelines.

Project 1 aims to determine prevalence of patients meeting criteria for PA screening among unselected hypertensive individuals using population-based registries and self-reported questionnaires. It will also evaluate screening rates and the number of identified PA cases. Additionally, this project will assess the interest of hypertensive individuals in undergoing PA screening. Project 2 is a prospective clinical trial on the diagnostic accuracy and feasibility of a pragmatic universal screening approach for PA. The trial will evaluate universal screening with non-standardized aldosterone/renin ratio (ARR) and compare it to the current guideline-recommended targeted screening approach, which uses standardized ARR under optimal testing conditions for high-risk individuals only. Project 3 is a prospective multicenter trial for determining if the novel 18F-CETO PET scan is superior to AVS in accurately diagnosing unilateral versus bilateral PA and predicting surgical cure, potentially offering a non-invasive alternative to AVS.

By addressing these challenges, the project aims to refine clinical guidelines with more reliable data, improve early detection and treatment of PA, and ultimately improve outcomes for the patients suffering from this common cause of severe hypertension.