Primary Aldosteronism Screening in Albanian Patients with Hypertension: Exploratory Findings from the Prospective PALPRE Study

Background Primary aldosteronism (PA) is a common cause of endocrine hypertension, yet prospective data from Albania are lacking. This exploratory study evaluated the frequency of a prespecified biochemical PA phenotype and its clinical characteristics among consecutive patients with hypertension attending a general cardiology outpatient clinic in Tirana. Methods Consecutive consenting adults referred for arterial hypertension to the Cardiology Outpatient Clinic of Catholic Hospital, Tirana, were prospectively recruited. Participants underwent a structured secondary-hypertension work-up, including standardized blood pressure assessment and biochemical evaluation after withdrawal of interfering antihypertensive medications. A biochemical PA phenotype was defined by an aldosterone-to-renin ratio (ARR) > 20.6 ng/mIU together with a plasma aldosterone concentration (PAC) >= 15 ng/dL. Results From April 2021 to December 2022, 94 of 126 consecutively assessed patients completed the diagnostic work-up. Seven participants (7.4%; 3 women and 4 men) met the prespecified biochemical criteria for PA. A unilateral adrenal nodule was identified in five of these seven participants. The proportion meeting biochemical criteria increased across hypertension stages, from 2.9% in stage 1 to 8.5% in stage 2 and 16.7% in stage 3, although estimates were imprecise because of the small number of screen-positive participants. A history of myocardial infarction was observed in 2 of 7 screen-positive participants and in none of the 87 remaining participants; given the very small number of events, this finding should be considered hypothesis-generating. Conclusions In this exploratory prospective cohort, 7.4% of hypertensive outpatients met prespecified biochemical criteria for PA. The observed frequency and the directional increase across hypertension-severity categories support the feasibility of systematic PA screening in this previously understudied setting. These findings are hypothesis-generating and require confirmation in larger, multicentre studies with comprehensive diagnostic and subtype assessment.