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In patients with resistant hypertension, establishing a diagnosis of primary aldosteronism (PA) can be challenging in primary care practice. One reason is the intra-individual variability in blood aldosterone levels.
Researchers examined this problem in a retrospective study of 216 Brazilian patients with hypertension, suppressed or low-normal plasma renin, and confirmed PA. All patients had two or more measurements of serum aldosterone and plasma renin (median, 3 measurements), done in the morning on different days. Key findings were as follows:
Intra-individual variability was substantial; for any cutoff chosen to identify serum aldosterone as elevated, many patients had at least one level above and one level below the cutoff.
At least one a…