Vnitr Lek 2026, 72(4):247-254 | DOI: 10.36290/vnl.2026.049

Primary aldosteronism: A review of the 2025 American-European Endocrine Society Clinical Practice Guidelines

Zdeněk Ramík^{1, 2}, Libor Jelínek³, Monika Beliančinová^{1, 2}, Martin Ráchela^{1, 2}, Jiří Vrtal^{1, 2}, Josef Dodulík^{1, 2}, Tomáš Kvapil⁴, Jan Václavík^{1, 2}

¹ Interní a kardiologická klinika, Fakultní nemocnice Ostrava

² Lékařská fakulta Ostravské univerzity

³ Klinika tělovýchovného lékařství a kardiovaskulární rehabilitace, Fakultní nemocnice Olomouc

⁴ I. interní klinika kardiologická, Fakultní nemocnice Olomouc

Primary aldosteronism represents a common and clinically important cause of secondary hypertension, the diagnosis and management of which have undergone substantial advances in recent years. The updated 2025 Endocrine Society clinical practice guidelines provide a structured framework for screening, laboratory diagnostics, disease confirmation, subtyping, and the selection of targeted therapy. Particular emphasis is placed on the expansion of screening indications, standardization of aldosterone-to-renin ratio interpretation with regard to the analytical method used, clinical stratification of patients according to the probability of lateralized aldosterone secretion, and rational use of confirmatory testing and adrenal venous sampling. A novel aspect is the assessment of biological treatment response using renin de-suppression as a marker of adequate mineralocorticoid receptor blockade. This review summarizes the key updates of the guidelines and discusses their practical application in the context of the Czech healthcare system, where local epidemiological data, availability of specialized diagnostic procedures, and organizational and capacity-related constraints must be taken into account.

Keywords: aldosterone-to-renin ratio, mineralocorticoid receptor antagonists, clinical practice guidelines, primary aldosteronism.

Accepted: June 11, 2026; Published: June 24, 2026  Show citation