THE ABCS OF PRIMARY ALDOSTERONISM: The Complete Clinical and Patient Resource for Understanding Hormonal Hypertension and Improving Cardiovascular Outcomes

Primary aldosteronism stands at a critical intersection of endocrinology, cardiovascular medicine, and public health yet for decades it has remained one of the most under-recognized and underdiagnosed causes of secondary hypertension worldwide. Traditionally considered a rare endocrine disorder, modern research has profoundly reshaped this perception, revealing primary aldosteronism not as an exception, but as a significant and often silent driver of high blood pressure, cardiovascular injury, and long-term organ damage.
At its core, primary aldosteronism is a disorder of hormonal imbalance originating from the adrenal cortex, where excessive and autonomous secretion of aldosterone disrupts the body’s delicate regulation of sodium, potassium, and fluid balance. This hormonal excess leads to persistent sodium retention, volume expansion, potassium depletion, and vascular remodeling—processes that collectively sustain hypertension and amplify cardiovascular risk far beyond that seen in essential hypertension alone. Importantly, this condition frequently occurs without obvious warning signs, and many individuals remain normokalemic, further masking its presence in routine clinical practice.
Over the past two decades, advances in molecular biology, imaging techniques, and endocrine testing have transformed the understanding of primary aldosteronism from a niche diagnosis into a common, treatable, and potentially curable form of hypertension. It is now well established that a substantial proportion of patients with resistant hypertension—or even apparently uncomplicated hypertension may have an underlying aldosterone-driven pathology. Despite this, widespread under-screening persists, leading to missed opportunities for targeted therapy and preventable cardiovascular complications.
This book is designed to bridge that gap between emerging scientific knowledge and practical clinical application. It provides a structured, accessible, and evidence-informed guide for clinicians, trainees, and patients seeking to understand the mechanisms, diagnosis, and management of this complex disorder.
Rather than treating primary aldosteronism as a purely biochemical curiosity, this work emphasizes its real-world clinical impact how it contributes to stroke, myocardial remodeling, kidney dysfunction, and persistent treatment-resistant hypertension. It also highlights the importance of early recognition, appropriate biochemical screening, confirmatory testing, and subtype classification, all of which are essential for guiding individualized therapy, including mineralocorticoid receptor antagonists or curative surgical intervention in selected cases.
Equally important, this book recognizes the patient perspective. A diagnosis of hormonal hypertension can be confusing and overwhelming, particularly when blood pressure appears resistant to conventional therapy. By translating complex endocrine concepts into clear, structured explanations, this resource aims to empower patients with knowledge, improve shared decision-making, and enhance long-term adherence to treatment strategies.
Ultimately, primary aldosteronism is not merely a disease of excess hormone production it is a paradigm of preventable cardiovascular risk. With timely diagnosis and targeted treatment, many of its consequences can be reversed or significantly reduced. The goal of this book is to make that possibility more widely understood and more consistently achieved in both clinical practice and patient care.