Beyond the Cuff: Does Cardiac Damage Truly Regress in Primary Aldosteronism?

Key Takeaway

For decades, primary aldosteronism was managed predominantly as a blood pressure disorder. This multicenter cohort study demonstrates that targeted therapy reverses left ventricular hypertrophy in more than half of affected patients, with adrenalectomy achieving significantly higher regression rates than medical management. Crucially, pre-treatment blood pressure and circulating aldosterone levels independently dictate the heart’s capacity for structural recovery.

A Heart Unexplained by Hypertension Alone

Consider a 49-year-old man taking three concurrent antihypertensive medications, presenting with borderline serum potassium levels, whose echocardiogram reveals a thickened, stiffened left ventricle more typical of a patient decades older. His blood pressure readings are finally approaching target range, and his medical chart quietly records a diagnosis of “essential hypertension.” For years, countless individuals with primary aldosteronism have languished in this diagnostic blind spot. The condition remains one of the most frequently missed causes of secondary hypertension, carrying a substantial excess risk of atrial fibrillation, stroke, chronic kidney disease, and left ventricular hypertrophy^[2]. This organ damage is far from theoretical: in a major multicenter cohort, nearly half of all patients already exhibited left ventricular hypertrophy at the time of diagnosis^[1]. A critical paradigm shift is long overdue:…