Aldosterone: The Hidden Cause of High Blood Pressure

Giving birth is typically a happy time for mothers, but for elementary school teacher Erin Consuegra, it brought unexpected health complications.

In 2013, after giving birth to her second child at 28, Consuegra developed extreme fatigue, fluttery heartbeats, and high blood pressure. Her doctor initially chalked it up to the mom being stressed and prescribed medication—but Consuegra wasn’t convinced.

Later testing revealed her body was producing too much aldosterone, which regulates blood pressure and fluid balance, which was behind her symptoms.

“It’s like, you think staying home all day with two kids is causing these real medical issues?” she says. “It was offensive to just write it all off to stress and anxiety.”

Taking Charge of Her Own Health

Determined to get to the root of her medical problems, Consuegra began doing her own research both online and through family members who are in the medical field.

During her digging, she came across a syndrome called primary aldosteronism. With aldosteronism, one or both adrenal glands (small structures that sit atop the kidneys) overproduce a hormone called aldosterone, according to the Cleveland Clinic.

Aldosterone sends sodium and water into the bloodstream, which can increase your blood volume and blood pressure. Besides the high blood pressure, Consuegra had something else in common with aldosterone: it lowers potassium, a mineral that Consuegra was already deficient in.

Although her primary care physician agreed to run a blood test for the condition, the doctor remained insistent that Consuegra’s results were normal.

Once again, Consuegra was not satisfied with the answer she was getting from her doctor, so she decided to request a referral to a specialist.

“She took it as me questioning her,” Consuegra shares of her request. Getting a referral, she adds, “took a lot of fighting, a lot of tears, a lot of advocacy on my part.”

What Does Aldosterone Do?

The aldosterone hormone is produced by the adrenal glands, which help regulate your blood pressure and fluid balance. It signals the kidneys to retain sodium and water while releasing potassium, which increases blood volume and, in turn, blood pressure.

While this is essential for normal body function, too much aldosterone—as seen in primary aldosteronism—can lead to dangerously high blood pressure, low potassium levels, and strain on the heart, kidneys, and blood vessels.

Understanding what aldosterone does helps explain why conditions like primary aldosteronism are often serious if left untreated. This is why early detection is so important.

Her Diagnosis

Eventually, Consuegra got answers at Vanderbilt University Medical Center. Doctors diagnosed her with primary aldosteronism and found a small noncancerous tumor, or adenoma, or adenoma, in one adrenal gland—the source of her symptoms.

After her diagnosis, surgeons removed her gland in July 2014, and she says her symptoms disappeared.

A Hidden Cause of High Blood Pressure

Unfortunately, for millions of other patients, they aren’t as lucky as Consuegra was to get a diagnosis. Although aldosteronism was first described more than six decades ago, less than one percent of cases are diagnosed and treated.

This is troubling because evidence shows that aldosteronism is a common cause of high blood pressure or hypertension.

According to a study by the Annals of Internal Medicine, aldosteronism can show up in people with mild, moderate, or even normal blood pressure.

“The prevalence of primary aldosteronism is high and largely unrecognized,” the study researchers wrote, adding that it may account for high blood pressure linked to genetics, poor diet, lack of exercise, and obesity.

Why So Many Aldosterone Cases Are Missed

Experts say the problem lies in awareness and testing. Many physicians don’t screen for aldosteronism, and the existing blood tests can be difficult to interpret. Research on the condition is behind, and few health systems have specialists who truly understand it.

According to the U.S. Centers for Disease Control and Prevention, nearly half of U.S. adults, or 116 million people, are classified as having high blood pressure. A widespread change in hypertension treatment is needed. Experts are calling on clinicians to prescribe more drugs that block aldosterone’s effects and to expand screening.

The Hidden Dangers of Misdiagnosis

A misdiagnosis can increase the risk for serious health complications because excess aldosterone is toxic to the heart, blood vessels, kidneys, and other organs. Those with primary aldosteronism face a higher risk of kidney disease, heart failure, coronary artery disease, and stroke compared to patients with standard hypertension.

“My personal frustration is seeing patients who’ve clearly had primary aldosteronism for more than a decade and now have irreversible kidney damage, which may require dialysis,” says endocrinologist William F. Young Jr. of the Mayo Clinic.

Although Young treats about 250 primary aldosteronism patients a year, he notes this is just “a drop in the bucket compared to what’s going on out there.”

“I think if physicians realize how common this truly is,” he adds, “they would start to look for it more often.”

Experts suggest increasing detection by removing the requirement that patients stop blood pressure medications before screening, which typically starts with a blood test called the aldosterone-to-renin ratio (ARR). This test measures the balance between the two hormones and can help flag cases of primary aldosteronism.

Some experts also recommend liberalizing cutoffs for a positive ARR result and using urine excretion tests, which are more reliable … but are also more expensive.

Some also advocate wider prescribing of drugs that target aldosterone, even as a first-line therapy for hypertension, according to The Lancet Diabetes & Endocrinology.

Patients Are Filling the Gaps

Much like with Consuegra, clinicians often miss symptoms, and patients are left to turn to Google, go from doctor to doctor, or go undiagnosed for years.

Because of limited awareness, many patients end up diagnosing themselves. “Unfortunately, I think my story is super typical,” Consuegra says. “People go from doctor to doctor or turn to Google for answers.”

She started a Facebook group to help others going through the same struggle. “I don’t think anyone has had an easy road to diagnosis,” she adds.

Getting Screened and Treated

The Endocrine Society, a medical organization dedicated to the advancement of hormone science and public health, recommends screening for primary aldosteronism if you have:

Low potassium
An adrenal mass found on a scan
Drug-resistant hypertension (uncontrolled despite three medications)
A family history of early-onset hypertension
Stroke before age 40

Screening usually involves the aldosterone-to-renin ratio (ARR) test, which costs around $150. If results are positive, additional tests can confirm whether surgery is an option. If both glands are overactive, medications that block aldosterone are usually prescribed instead.

Doctors may also suggest: