Differentiating Primary Aldosteronism from Essential Hypertension: A Systematic Review and Meta-Analysis of Biochemical and Renal-Metabolic Profiles for Endocrine Hypertension Screening

By
Xuan Zhao
Caiyan Zhang
Chunxiu Yi
Xinyi Liu
Shujun Ding
Wen Zhang
Yajing Zhao
September 15, 2026

Frontiers In Endocrinology

Objective:

To compare electrolyte and renal-metabolic profiles between primary aldosteronism (PA) and essential hypertension (EH), while assessing unilateral/lateralizing versus bilateral PA.

Approach:

Search Strategy: Database searches covered records from inception through July 13, 2026, using PubMed, Embase, Web of Science, and the Cochrane Library.
Study Selection: Included observational studies with biochemically confirmed PA and relevant outcomes.
Data Analysis: Random-effects meta-analyses synthesized standardized mean differences (SMD) and conducted subgroup, sensitivity, and meta-regression analyses.

Key Findings:

PA was characterized by a serum potassium reduction (SMD = −1.15, 95% CI −1.27 to −1.02) and a sodium increase (SMD = 0.51, 95% CI 0.38 to 0.63) compared to controls.
Lower uric acid levels were found in PA (SMD = −0.23, 95% CI −0.35 to −0.12).
Unilateral/lateralizing PA had lower potassium levels than bilateral PA (SMD = −0.85).
Elevated urinary albumin-to-creatinine ratio (UACR) (SMD = 0.49, 95% CI not provided) and urinary albumin excretion (SMD = 0.73, 95% CI not provided) were observed in PA.

Limitations:

The study is limited to observational data, which may introduce biases.
Variability in diagnostic criteria and methods across studies may affect results.