Rethinking Primary Aldosteronism: The 2025 John H. Laragh Research Award.

Dr John Laragh, a pioneer in the field of hypertension, held a fundamental belief in the need to challenge existing dogmas in medicine to enhance our scientific understanding of disease and advance patient care. Perhaps in no area of hypertension does this ring truer with than primary aldosteronism (PA). Following its initial description in the mid-1950s with an initial surge in diagnoses soon thereafter, PA was ultimately relegated to be considered a "zebra" of hypertension felt to be responsible for only a small percentage of cases.

Guide de pratique clinique en soins de première ligne d'Hypertension Canada pour le diagnostic et le traitement de l'hypertension artérielle chez les adultes.

Contexte: Le Canada a longtemps figuré parmi les leaders mondiaux de la prise en charge de l'hypertension artérielle (HTA), mais ses taux de traitement et de maîtrise de l'HTA ont régressé ces dernières années. Le présent guide de pratique clinique vise à fournir des recommandations pragmatiques axées sur les soins de première ligne afin d'améliorer la prise en charge de l'HTA chez les adultes à l'échelle de la population.

MÉthodes: Conformément aux normes de qualité et de présentation du guide AGREE II (Appraisal of Guidelines for Research and Evaluation), nous avons utilisé la méthode GRADE (Grading of Recommendations Assessment, Development and Evaluation) et le processus ADAPTE pour formuler des recommandations sur la prise en charge de l'HTA chez les adultes de 18 ans et plus.

Interventions to Reduce the Risk of Hypocalcemia After Parathyroidectomy for People With Advanced Chronic Kidney Disease: A Systematic Review.

Background: People with advanced chronic kidney disease (CKD) and secondary hyperparathyroidism (sHPT) refractory to medical therapy often require surgical parathyroidectomy. Severe and prolonged hypocalcemia immediately following parathyroidectomy for sHPT is often termed "hungry bone syndrome" (HBS).

Objective: To systematically review the effect of pre-operative interventions on post-operative hypocalcemia, HBS, and other related outcomes in patients with CKD and sHPT undergoing parathyroidectomy.

Guide de pratique clinique en soins de première ligne d'Hypertension Canada pour le diagnostic et le traitement de l'hypertension artérielle chez les adultes.

Contexte: Le Canada a longtemps figuré parmi les leaders mondiaux de la prise en charge de l'hypertension artérielle (HTA), mais ses taux de traitement et de maîtrise de l'HTA ont régressé ces dernières années. Le présent guide de pratique clinique vise à fournir des recommandations pragmatiques axées sur les soins de première ligne afin d'améliorer la prise en charge de l'HTA chez les adultes à l'échelle de la population. MÉTHODES: Conformément aux normes de qualité et de présentation du guide AGREE II (Appraisal of Guidelines for Research and Evaluation), nous avons utilisé la méthode GRADE (Grading of Recommendations Assessment, Development and Evaluation) et le processus ADAPTE pour formuler des recommandations sur la prise en charge de l'HTA chez les adultes de 18 ans et plus.

A Systematic Review and Meta-Analysis Comparing Mortality between Inhospital versus Community-Onset Acute Ischemic Stroke.

Introduction: Patients who experience inhospital strokes may suffer from delays in stroke recognition, delays to acute treatment and management. We aimed to assess evidence for the difference in mortality between patients with inhospital stroke and those with community-onset stroke.

Methods: We searched MEDLINE, EMBASE, and SCOPUS (from inception to October 8, 2024) to identify studies comparing mortality outcomes for inhospital and community-onset stroke patients.

Subclinical Primary Aldosteronism and Major Adverse Cardiovascular Events: A Longitudinal Population-Based Cohort Study.

Background: Primary aldosteronism (PA), an overt form of renin-independent aldosterone production, leads to a disproportionately high rate of major adverse cardiovascular events (MACEs). Mounting evidence suggests that milder forms of renin-independent aldosterone production (subclinical PA) are highly prevalent; however, the link between subclinical PA and MACE remains uncertain.

Methods: This prospective study included 2017 Canadian adults 40 to 69 years of age from the randomly sampled, population-based CARTaGENE cohort (Québec, Canada), in which aldosterone and renin concentrations at enrollment (2009-2010) were measured.

Incidence of adrenal masses eventually discovered in patients screened for primary aldosteronism.

Context: Biochemical screening for endocrine hypertension may be complex; the known presence of an adrenal mass markedly increases the pre-test probability for adrenal hypertension and may inform diagnostic efforts.

Objective: Model the potential incidence of adrenal masses that may be detected by routine adrenal imaging in patients with suspected endocrine hypertension.

Design: Retrospective cohort study.

Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care.

Background: Canada has historically been among the world's leaders in hypertension care, but hypertension treatment and control rates have regressed in recent years. This guideline is intended to provide pragmatic primary care-focused recommendations to improve hypertension management in adults at the population level.

Methods: We employed Grading of Recommendations Assessment, Development and Evaluation and ADAPTE frameworks in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards to develop recommendations on managing hypertension for adults aged 18 years and older.

Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care.

Background: Canada has historically been among the world leaders in hypertension care, but hypertension treatment and control rates have regressed in recent years. This guideline is intended to provide pragmatic primary care-focused recommendations to improve hypertension management in adults at the population level.

Methods: We employed Grading of Recommendations Assessment, Development and Evaluation and ADAPTE frameworks in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards to develop recommendations on managing hypertension for adults aged 18 years and older.

Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care.

Background: Canada has historically been among the world leaders in hypertension care, but hypertension treatment and control rates have regressed in recent years. This guideline is intended to provide pragmatic primary care-focused recommendations to improve hypertension management in adults at the population level.

Methods: We employed Grading of Recommendations Assessment, Development and Evaluation and ADAPTE frameworks in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards to develop recommendations on managing hypertension for adults aged 18 years and older.

Confirmatory Testing for Primary Aldosteronism : A Study of Diagnostic Test Accuracy.

Background: Confirmatory testing to verify the diagnosis of primary aldosteronism (PA) in patients who have an abnormal screening result is of uncertain benefit.

Objective: To perform a blinded assessment of the seated saline suppression test (SSST).

Design: Diagnostic test accuracy study.

Big data determination and validation of reference range for 24-h urine cortisol by liquid chromatography-mass spectrometry.

Objective: Twenty-four-hour urine-free cortisol (UFC) is a first-line test for Cushing syndrome (CS). A new mass spectrometry assay for UFC requires a validated, relevant reference range appropriate to a screening population.

Design: Combined retrospective and prospective cohort study in a government health system and tertiary endocrinology clinic, Canada.

Implications of Inaccurate Blood Pressure Measurement on Hypertension Prevalence.

Background: The cornerstone of the management of hypertension is accurate measurement of blood pressure (BP). A recent study showed that more than one-half of home BP devices sold in Canada have no evidence of validation for accuracy. The purpose of this study was to model the implications of inaccurate BP measurements on diagnosis and control of hypertension.

Development of Prompt Templates for Large Language Model-Driven Screening in Systematic Reviews.

Background: Systematic reviews (SRs) are hindered by the initial rigorous article screen, which delays access to reliable information synthesis.

Objective: To develop generic prompt templates for large language model (LLM)-driven abstract and full-text screening that can be adapted to different reviews.

Design: Diagnostic test accuracy.

Discordance between adrenal vein sampling and imaging: the role of unilateral cortisol excess.

Objective: Adrenal vein sampling (AVS) is considered the gold-standard for identifying unilateral primary aldosteronism (PA), but is sensitive to any asymmetry in cortisol production. Subclinical autonomous cortisol production likely contributes to discordance between cross-sectional imaging and AVS.

Design And Methods: Retrospective chart review was performed of patients in Calgary, Alberta who (1) had a diagnosis of PA with clear adrenal mass, (2) had discordant AVS and cross-sectional imaging, and (3) underwent dexamethasone-suppressed NP59-iodocholesterol adrenal scintigraphy (n = 25).

Use of Albumin-Adjusted Calcium Measurements in Clinical Practice.

Importance: Using albumin-adjusted calcium is commonly recommended for for measuring calcium, but with little empirical evidence to support the practice.

Objective: To assess the correlation between total calcium measurements (with or without adjustment) vs the ionized calcium level as a reference standard.

Design, Setting, And Participants: This was a population-based cross-sectional study in the province of Alberta, Canada, including adults tested for serum total calcium and ionized calcium simultaneously between January 1, 2013, and October 31, 2019.

Prevalence, Patient Awareness, Treatment, and Control of Hypertension in Canadian Adults With Common Comorbidities.

Background: Whether certain medical conditions are associated with blood pressure (BP) treatment and control is unclear.

Methods: Using the Canadian Health Measures Survey (2007-2019), BP was assessed according to the presence of selected comorbidities, including prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus, obstructive sleep apnea, and overweight or obesity.

Results: A total of 5,841,453 people, representing 23.

Prevention and Management of Cardiovascular Disease in Primary Care: A Comment on the PEER Simplified Lipid Guideline.

Background: In Canada, 2 guidelines provide guidance for the management of dyslipidemia. The Patients, Experience, Evidence, Research simplified lipid guidelines, intended for primary care practitioners, and the Canadian Cardiovascular Society guidelines, intended for all practitioners, are based on differing methodologies with distinct priorities and preferences. The disparate approaches may contribute to confusion among family practitioners and their co-managed patients, with the potential for compromised care, differing standards for training in the fundamentals of lipidology, and differing criteria that might be used in practice audits to evaluate quality of care.

Cushing syndrome from an ACTH-producing pheochromocytoma or paraganglioma: structured review of 94 cases.

Adrenocorticotropic hormone-producing pheochromocytomas/paragangliomas are rare neuroendocrine tumors that co-secrete excess catecholamines and adrenocorticotropic hormone, resulting in Cushing syndrome (CS). This review aims to summarize important patient characteristics, investigations, and outcomes in all cases reported in the English literature. A literature search was conducted to identify all English-language case reports and case series describing adrenocorticotropic hormone-producing pheochromocytomas/paragangliomas.

Sex-specific Associations of Aldosterone and Renin With Body Composition: A Population-based Cohort Study.

Context: Renin-angiotensin-aldosterone system (RAAS) activation is closely linked to obesity; however, the sex-specific associations between RAAS activity and body composition among individuals without obesity are not well understood.

Objective: To investigate the associations of aldosterone and renin with body composition according to sex in the general population.

Design: Population-based cohort study.

Measurements of Postmenopausal Serum Estradiol Levels and Cardiovascular Events: A Systematic Review.

Background: Cardiovascular disease (CVD) is the leading cause of death among female patients and its likelihood increases following menopause. However, whether estradiol levels are related to CVD remains unknown. We aimed to determine the association between serum estradiol levels and cardiovascular (CV) events in postmenopausal females.

Characterizing Hypertension Specialist Care in Canada: A National Survey.

Background: The hypertension specialist often receives referrals of patients with young-onset, severe, difficult-to-control hypertension, patients with hypertensive emergencies, and patients with secondary causes of hypertension. Specialist hypertension care compliments primary care for these complex patients and contributes to an overall hypertension control strategy. The objective of this study was to characterize hypertension centres and the practice patterns of Canadian hypertension specialists.