The diagnosis of primary aldosteronism generally re- quires a confirmatory test (intravenous saline suppression test or oral salt-loading test).S5.4.2-2,S5.4.2-3 If the diagnosis of primary aldosteronism is confirmed (and the patient agrees that surgery would be desirable), the patient is re- ferred for an adrenal venous sampling procedure to de- termine whether the increased aldosterone production is unilateral or bilateral in origin. If unilateral aldosterone production is documented on adrenal venous sampling, the patient is referred for unilateral laparoscopic adrenal- ectomy, which improves BP in virtually 100% of patients and results in a complete cure of hypertension in about If the patient has bilaterally increased aldosterone secretion on adrenal venous sampling or has a unilateral source of excess aldosterone production but cannot undergo surgery, the patient is treated with spi- ronolactone or eplerenone as agent of choice.S5.4.2-2,S5.4.2-3 Both adrenalectomy and medical ktherapy are effective in lowering BP and reversing LVH. Treating primary al- dosteronism, either by mineralocorticoid receptor antag- onists or unilateral adrenalectomy (if indicated), resolves hypokalemia, lowers BP, reduces the number of antihy- pertensive medications required, and improves param- eters of impaired cardiac and kidney function.S5.4.2-9,S5.4.2-10 5.4.3. Renal Artery Stenosis Recommendations for Renal Artery Stenosis References that support recommendations are summarized in Online Data Supplements 7 and 24. COR LOE Recommendations I A 1. Medical therapy is recommended for adults with atherosclerotic renal artery IIb C-EO 2. In adults with renal artery stenosis for whom medical management has failed (refractory hypertension, worsening renal function, and/or intractable HF) and those with nonatherosclerotic disease, including fibromuscular dysplasia, it may be reasonable to refer the patient for consideration of revascularization (percutaneous renal artery angioplasty and/ or stent placement). Synopsis Renal artery stenosis refers to a narrowing of the renal artery that can result in a restriction of blood flow. 