After more than 30 years of treating hypertension, the 'culprit' has finally been found.

After suffering from hypertension for 30 years, along with unexplained hypokalemia for many years, a Filipino man was found to have primary hyperaldosteronism.

Mr. LC (61 years old, Filipino nationality) came to Hong Ngoc General Hospital for examination with a high blood pressure of 160/100 mmHg. He shared that he had been treated for hypertension for over 30 years and had suffered from hypokalemia for over 20 years, but the cause had never been determined.

Despite using a combination of antihypertensive medications, the patient's blood pressure frequently fluctuated and was difficult to control. Notably, the patient also had a history of stroke, increasing the risk of cardiovascular complications and complicating the treatment process.

Advanced tests revealed that aldosterone levels – a hormone that regulates salt and water balance in the body – were nearly three times higher than normal. Meanwhile, renin, a hormone involved in regulating blood pressure, was very low, only about one-third of the minimum level. At the same time, the patient's blood potassium level was only 2.92 mmol/L, significantly lower than the safe threshold.

These indicators show a high aldosterone/renin ratio accompanied by persistent hypokalemia, meeting the diagnostic criteria for primary hyperaldosteronism – an endocrine disorder that can cause refractory hypertension and increase the risk of stroke and myocardial infarction.

According to MSc. Dr. Kieu Hong Nhung, Department of Endocrinology, Hong Ngoc General Hospital, primary hyperaldosteronism is a condition where one or both adrenal glands produce excessive amounts of the hormone aldosterone. When this hormone is abnormally high, the body retains more salt and water than normal, leading to prolonged high blood pressure and increased potassium excretion through the kidneys, causing hypokalemia.

This is considered one of the most common causes of secondary hypertension, yet it is often overlooked if patients do not undergo thorough screening.

To accurately determine the cause of the increased hormone secretion, the patient underwent a 2560-slice CT scan. The results revealed tumors in both adrenal glands, with the left adrenal gland measuring 8 x 11 mm and the right gland approximately 14 mm.

Adrenal vein blood sampling - Photo courtesy of the hospital.

To clarify the source of aldosterone hypersecretion, the Endocrinology team collaborated with interventional radiologists to perform adrenal vena cava sampling (AVS).

This is considered the "gold standard" in diagnosing primary hyperaldosteronism, helping to accurately pinpoint the location of the adrenal glands that are oversecreting the hormone.

The AVS results showed that both adrenal glands were secreting excessive aldosterone. From this, the doctors determined that the patient had primary hyperaldosteronism due to bilateral adrenal hyperplasia – the true cause of the persistent hypertension and hypokalemia over many years.

Immediately after the underlying cause is correctly identified, the patient is treated with aldosterone antagonists according to a specialized medical protocol.

Following treatment, blood pressure improved significantly, although the amount of antihypertensive medication needed was considerably reduced. Blood potassium levels also returned to safe levels, and the patient's health stabilized quickly.

Experts recommend that individuals with chronic hypertension, especially those whose blood pressure is difficult to control despite multiple medications or who experience unexplained hypokalemia, should be screened for endocrine causes.

Early detection of primary hyperaldosteronism not only helps control blood pressure more effectively but also reduces the long-term risk of stroke, heart attack, and kidney damage.

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