Excess aldosterone as a mechanism of resistant salt-sensitive arterial hypertension

Albeit vastly underdiagnosed, primary aldosteronism is the most common cause of arterial hypertension and particularly of drug-resistant arterial hypertension, a high-risk condition with a poor prognosis. A timely diagnosis followed by targeted treatment is pivotal to prevent the cardiovascular morbidity and mortality related to the detrimental consequences of aldosterone excess. This doctoral thesis highlights the importance of the screening for primary aldosteronism in patients with resistant hypertension, even if they are on multiple drugs potentially confounding the diagnosis. These patients can benefit from surgical treatment, resolve their resistance to treatment and improve their quality of life. Moreover, for the first time, the sodium accumulation in the skin of these patients was evaluated, which was found to be reversible after surgery, suggesting the presence of tissue-specific regulatory mechanisms that act in the pathophysiology of hypertension. In this regard, it has been speculated that tissue sodium storage might represent an independent cardiovascular risk factor and that it might be responsible of the target organ damage in patients with primary aldosteronism.