Biochemical and renal-metabolic profiles distinguishing primary aldosteronism from essential hypertension: a systematic review and meta-analysis with implications for endocrine hypertension screening.

Authors

Xuan Zhao, Caiyan Zhang, Chunxiu Yi, Xinyi Liu, Shujun Ding, Wen Zhang, Yajing Zhao

Published in

Frontiers in endocrinology. Volume 17. Pages 1916237. Epub Sep 15, 2026.

Abstract

To characterize electrolyte and renal-metabolic profiles in primary aldosteronism (PA) compared with essential hypertension (EH), and to examine differences between unilateral/lateralizing and bilateral PA.
PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception through 13 July 2026. Random-effects meta-analyses pooled standardized mean differences (SMD; Hedges' g), supplemented by clinical-unit mean-difference analyses, subgroup analyses, sensitivity analyses, and study-level meta-regression.
A total of 74 observational studies involving 26,143 participants were included. Compared with hypertensive controls, PA was associated with lower serum potassium (SMD = -1.15, 95% CI -1.27 to -1.02), higher serum sodium (SMD = 0.51, 95% CI 0.38 to 0.63), and lower uric acid (SMD = -0.23, 95% CI -0.35 to -0.12), whereas creatinine, estimated glomerular filtration rate (eGFR), and blood urea nitrogen (BUN) did not differ significantly. Corresponding PA-minus-control mean differences were -0.49 mmol/L for potassium, +1.20 mmol/L for sodium, and -20.7 μmol/L for uric acid. Potassium was lower in unilateral/lateralizing than in bilateral PA (SMD = -0.85). The potassium difference versus controls was greater in studies with high plasma aldosterone concentration (PAC) than in those with low PAC (SMD -1.44 vs. -1.03; p for subgroup difference = 0.010), although continuous PAC meta-regression was not significant. UACR/ACR and urinary albumin excretion were higher in PA (SMD = 0.49 and 0.73).
PA shows a persistent electrolyte phenotype and higher albuminuria despite similar cross-sectional filtration markers. These findings support renal assessment with UACR alongside routine filtration measures and reinforce that PA screening should not depend on overt hypokalemia alone.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261286832.

PMID:
42812167
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

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