Which finding is characteristic of primary hyperaldosteronism?

• A. Refractory hypertension with hypokalemia and metabolic alkalosis
• B. Hypertension with edema
• C. Hypotension with hyponatremia
• D. Hypokalemic metabolic acidosis with normal blood pressure

Answer: (A)

Primary hyperaldosteronism causes autonomous excess aldosterone, which increases sodium reabsorption in the distal nephron and enhances potassium and hydrogen ion loss. The result is volume expansion with hypertension, along with hypokalemia and a metabolic alkalosis from the ongoing H+ loss. Edema is not typically seen because the body adapts (aldosterone escape), so the most characteristic picture is hard-to-control hypertension with low potassium and a high bicarbonate, i.e., metabolic alkalosis.

That’s why the finding described—refractory hypertension with hypokalemia and metabolic alkalosis—best fits primary hyperaldosteronism. The other options don’t align: edema is not a typical feature; hypotension with hyponatremia contradicts the common sodium handling and hypertensive state; and hypokalemic metabolic acidosis contradicts the metabolic alkalosis seen with aldosterone excess.