“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #119

Sphygmomanometer  - ds_30 / Pixabay

Have a patient with stubborn hypertension? Have you tried multiple medications, yet their blood pressure has not made any significant or consistent progress? Then consider checking the patient’s aldosterone level.

Remember, aldosterone is the principal mineralocorticoid in the human body. It is produced in the adrenal gland and its predominant physiologic effect is to increase reabsorption of sodium in the kidney. What does this result in? Increased fluid volume which leads to ELEAVATED BP!

It is estimated that up to 10% of individuals with essential hypertension could have elevated aldosterone levels, therefore it should be a part of your laboratory evaluation in patients with hypertension that are not improving with standard hypertensive medications. This condition is often undiagnosed and undertreated.

Your job is to simply detect this disorder and refer to endocrinology. Check a plasma aldosterone concentration in your patients with stubborn hypertension and then refer to endocrinology if elevated.

As always, use your best clinical judgement!

4 Responses

  1. Hey Justin, how are you?
    I’m Orlando from FL, nephrology nurse practitioner and recently resigned my job. I’m starting with my wife Jeila Pujols DNP a Testosterone clinic, weight management and IV hydration clinic. Thank you for inspiring us. Based on my experience in nephrology one of the best way to r/o secondary htn is cheking an aldosterone to renin ratio. If is more than 23 then order an abd CT loking for adrenal adenomas. Thanks again for your support and everything you’re doing for the NP comunity. Blessings.

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