Model schematic for intervention strategies (i.e. SIT/CT/AVS, CT/AVS, SIT/AVS, AVS only, SIT/CT, and CT only). True underlying cause of hypertension (primary hypertension versus PA) and subtype of PA (“unilateral” = APA; “bilateral” = BAH) are based on prevalence in the population of RH patients. All patients in the intervention strategies undergo screening with ARR. Strategies differ on use of SIT, CT, and AVS (Table 1).
APA: Aldosterone-producing adenoma; ARR: Aldosterone-renin ratio; AVS: Adrenal venous sampling; BAH: Bilateral adrenal hyperplasia; SIT: Saline-infusion testing; TP: true-positive given etiology of hypertension; FN: false-negative; MRA: Mineralocorticoid-receptor antagonist.