Similarly, specific treatment often requires a level of technical training and experience. 5.4.1. Drugs and Other Substances With Potential to Impair BP Control Numerous substances, including prescription medications, over-the-counter medications, herbals, and food substances, may affect BP (Table 14).S5.4.1-1 S5.4.1-6 Changes in BP that occur because of drugs and other agents have been associ- ated with the development of hypertension, worsening con- trol in a patient who already has hypertension, or attenuation of the BP-lowering effects of antihypertensive therapy. A change in BP may also result from drug drug or drug food In the clinical assessment of hyper- tension, a careful history should be taken with regard to sub- stances that may impair BP control, with close attention paid to not only prescription medications, but also over-the-counter substances, illicit drugs, and herbal products. When feasible, drugs associated with increased BP should be reduced or dis- continued, and alternative agents should be used. 5.4.2. Primary Aldosteronism Recommendations for Primary Aldosteronism COR LOE Recommendations I C-EO 1. In adults with hypertension, screening for primary aldosteronism is recommended in the presence of any of the following concurrent conditions: resistant hypertension, hypokalemia (spontaneous or substantial, if diuretic induced), incidentally discovered adrenal mass, family history of early-onset hypertension, or stroke at a young age (<40 years). I C-LD 2. Use of the plasma aldosterone: renin activity ratio is recommended when adults are screened for primary aldosteronism.S5.4.2-1 I C-EO 3. In adults with hypertension and a positive screening test for primary aldosteronism, referral to a hypertension specialist or endocrinologist is recommended for further evaluation and treatment. 