Which combination of findings should raise suspicion for primary hyperaldosteronism?

• A. Resistant hypertension
• B. Hypokalemia
• C. Resistant hypertension and hypokalemia
• D. Hyperkalemia

Answer: (B)

High aldosterone activity drives potassium loss in the kidneys, so hypokalemia is a key clue when evaluating a patient with hypertension. In primary hyperaldosteronism, the adrenal glands secrete excess aldosterone independent of renin, leading to sodium retention and increased potassium excretion in the distal nephron. That potassium-wasting effect produces low potassium levels, which stands out as a specific finding suggesting this diagnosis.

Hyperkalemia would not fit with excess aldosterone, since aldosterone drives potassium loss, not retention. While resistant hypertension is common in primary hyperaldosteronism, it is non-specific and can occur with many other conditions; the presence of low potassium makes the suspicion much stronger. Therefore, isolated hypokalemia is the best single clue among the options to raise suspicion for primary hyperaldosteronism.