invited review January 01, 2026 January 01, 2026

Subclinical primary aldosteronism

DOI: 10.20945/2359-4292-2025-0400

ABSTRACT

Primary aldosteronism (PA) is a major contributor to hypertension and cardiovascular disease. Subclinical PA, a preclinical or early manifestation of PA, has been identified in individuals with normal blood pressure and in those with mild hypertension without signs or symptoms of overt PA, using evidence from histopathology, hormonal biochemistry, proteomic, and genetic studies. Longitudinal studies have shown that subclinical PA increases the risk for developing incident hypertension, adverse cardiovascular remodeling, major adverse cardiovascular events, and chronic kidney disease. Given the clinical relevance of subclinical PA on the pathogenesis of cardiorenal disease, future studies should focus on methods to enhance early detection and assessment of the impact of early aldosterone-directed interventions for preventing adverse clinical outcomes.