The current screening and diagnostic recommendations for detecting Primary Hyperaldosteronism (PHA) focus on diagnosing the more severe and overt instances of renin-independent aldosterone production. However, milder forms of autonomous aldosterone secretion have been demonstrated to exist below the diagnostic thresholds of current PHA guidelines, and associate with clinically relevant cardiovascular risk. PHAencompasses a spectrum of renin independent aldosterone production, progressing from a subclinical state in normotensives to a full-blown clinical syndrome representing the resistant hypertension population. The authors propose the Syndrome of Inappropriately Elevated Aldosterone Secretion (SIALDS) concept as a potential new paradigm for understanding and diagnosing PHA and expanded diagnostic approach to improve early detection even in well-controlled hypertension. The authors also delve into the impact of treatments, including mineralocorticoid receptor antagonists and emerging aldosterone synthase inhibitors. Furthermore, The authors outline future research directions, proposing clinical trials to investigate the long-term identification and treatment outcomes of SIALDS.

中文翻译：

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将原发性醛固酮增多症重新定义为“醛固酮分泌不当综合征 (SIALDS)”：一种常见但未被认识的高血压原因

目前用于检测原发性醛固酮增多症 (PHA) 的筛查和诊断建议侧重于诊断更严重和明显的不依赖于肾素的醛固酮生成情况。然而，较温和形式的自主醛固酮分泌已被证明低于当前 PHA 指南的诊断阈值，并且与临床相关的心血管风险相关。PHA 包括一系列不依赖于肾素的醛固酮产生，从血压正常的亚临床状态进展为代表顽固性高血压人群的全面临床综合征。作者提出醛固酮分泌异常升高综合征 (SIALDS) 概念作为理解和诊断 PHA 的潜在新范例，并扩展诊断方法以改善早期检测，即使是在控制良好的高血压中。作者还深入研究了治疗的影响，包括盐皮质激素受体拮抗剂和新兴的醛固酮合酶抑制剂。此外，作者概述了未来的研究方向，提出了研究 SIALDS 的长期识别和治疗结果的临床试验。