A recent clinical study has determined that the seated saline suppression test (SSST), a long-standing follow-up tool used after screening for primary aldosteronism (PA), does not reliably predict treatment success.
The researchers emphasize that removing the SSST from the diagnostic pathway may help patients begin effective treatment faster.
“Confirmatory testing with the SSST adds little to the diagnostic work-up in patients who already have a positive result on a screening test,” the study authors wrote. “Rather, reliance on the SSST may misinform downstream treatment decisions and lead to missed opportunities for intervention, even in patients who would clearly respond to treatment.”
Key takeaways
- Primary aldosteronism affects up to 30% of patients with high blood pressure.
- The SSST may incorrectly rule out patients who could benefit from treatment.
- A Canadian study finds the SSST does not correlate with treatment outcomes.
- Eliminating the test may improve diagnosis speed and precision.
- Treatments include adrenal gland surgery and aldosterone-blocking medications.
Contents
What Is Primary Aldosteronism and Why It Matters
Primary aldosteronism is a hormone disorder in which the adrenal glands secrete excessive aldosterone, disrupting sodium-potassium balance.
This hormonal imbalance results in salt retention and increased blood pressure.
The condition is a common but underdiagnosed cause of secondary hypertension.
Despite the availability of effective treatments, fewer than 1% of patients are diagnosed and treated for PA due to diagnostic barriers.
What the SSST Does — And Why It’s Failing
The SSST has traditionally been used as a confirmatory test for PA after a patient screens positive.
It involves an IV saline infusion during which aldosterone levels are measured to assess hormonal suppression.
Persistent high aldosterone levels under saline are thought to confirm the PA diagnosis.
However, recent evidence indicates that this interpretation may not hold true in clinical settings.
“This represents a large paradigm shift in the field of hypertension,” said Dr. Alexander Leung, associate professor of medicine at the University of Calgary and lead author of the study.
Study Design: Challenging the Diagnostic Status Quo
The research team enrolled 156 patients between January 2017 and August 2024, all of whom had screened positive for PA.
Each patient underwent the SSST and then received treatment regardless of SSST outcome.
Treatments included adrenalectomy (surgical removal of an overactive adrenal gland) or pharmacologic therapy to block aldosterone.
Researchers used treatment response as the definitive indicator of whether the patient truly had PA.
The Results: SSST Could Not Predict Treatment Success
The study found that SSST results did not correlate with whether a patient improved after receiving therapy.
Patients who responded well to treatment were often misclassified as “normal” by SSST, suggesting false negatives.
“The results of our study suggest that removal of routine confirmatory testing from the diagnostic care pathway for PA may help to improve diagnostic accuracy and reduce the time needed for diagnosis and treatment for most patients,” the authors concluded.
These misclassifications would have prevented many patients from being treated under the current diagnostic framework.
What This Means for Doctors and Patients
The findings challenge existing guidelines that recommend the SSST after a positive screening.
Doctors are now encouraged to consider initiating treatment without SSST confirmation in appropriate patients.
This change could reduce diagnostic delays and improve outcomes for those with aldosterone-related hypertension.
“Getting rid of this inaccurate test could improve diagnostic accuracy and reduce time to treatment,” Dr. Leung said in a university press release.
Who Should Be Screened and Treated More Quickly?
Patients with treatment-resistant hypertension or unexplained low potassium should be screened for PA.
Clinicians are advised to use a positive screening result as sufficient basis to begin treatment.
By bypassing SSST, clinicians can initiate timely interventions that prevent long-term cardiovascular damage.
Conclusion: A New Standard for Diagnosing Primary Aldosteronism
This landmark study calls for a revision of diagnostic protocols to improve care delivery in patients with high aldosterone.
Abandoning routine SSST may help address one of the major bottlenecks in hypertension treatment.
With faster diagnosis, more patients can access surgery or medication that meaningfully improves blood pressure control.
Robin Backlund is a dedicated journalist and a medical student who has written several articles and essays exposing the falseness and hollowness of online resources in the medical science niche.