THE 2020 ITALIAN SOCIETY OF HYPERTENSION (SIIA) PRACTICAL GUIDELINES FOR THE MANAGEMENT OF PRIMARY ALDOSTERONISM

Abstract

Objective: Considering the amount of novel knowledge generated in the last five years, a team of experienced hypertensiologists was assembled to furnish updated clinical practice guidelines for the management of primary aldosteronism (PA). Design and method: They were asked to undertake a systematic review of the literature in international databases by using the PICO strategy, to identify the most relevant studies and to grade their quality. Predefined quality criteria were in compliance with STARD (Standards for Reporting of Diagnostic Accuracy) recommendations. Each section of the guidelines was then jointly prepared by at least two coauthors, who provided, whenever possible, a Class of Recommendation and Level of Evidence, following the American Heart Association (AHA) methodology. The resulting guidelines underwent two rounds of revision, followed by review by an External Committee, two face-to-face meetings with all coauthors to clarify standing queries, a joint presentation on occasion of the 36th SIIA Conference to gather further feedbacks by the all Society members and, on these bases, a further conclusive peer review. Results: As a potentially curable cause of hypertension, PA should always be suspected in hypertensive patients and identified in a cost-effective manner by physicians dealing with these patients. Screening for PA is particularly beneficial when hypertension is severe and/or resistant to treatment, because target treatment and/or surgery allows to control BP, to withdraw or markedly reduce the number and dosage of antihypertensive medications, and to prevent or regress organ damage and associated comorbidities. Subtyping should be performed at third level referral centers that are proficient in performing and interpreting AVS. Adrenalectomy usually cure hyperaldosteronism and hypokalemia when a unilateral cause of PA is discovered; BP can also be normalized or considerably reduced in a substantial proportion of patients. Even when subtyping is unfeasible/failed, identification of PA allows undertaking a target treatment, which will provide better control of high BP. Conclusions: The proposed guidelines, offering substantial updated information, could simplify the diagnosis of PA and assist practicing physicians in the optimization of treatment and follow-up of patients with one of the most common curable causes of arterial hypertension.