Primary aldosteronism (hyperaldosteronism) Quiz: Ace Your Exams

A 56-year-old woman has a follow up appointment with her primary care physician because of persistent hypertension resistant to four antihypertensive medications. Over the past few months, she has experienced fatigue and muscle weakness. Past medical history is significant for hypothyroidism and osteoarthritis. Family history is non-contributory. Temperature is 37.1°C (98.8°F), blood pressure is 160/95 mmHg, pulse is 78/min, respiratory rate is 16 breaths/min, and oxygen saturation is 99% on room air. Physical examination is unremarkable. Laboratory evaluation is significant for a potassium level of 3.0 mEq/L, plasma aldosterone-to-renin ratio of 30, plasma renin activity < 1 ng/mL/hour and plasma aldosterone concentration ≥ 20 ng/dL. A CT scan of the adrenal glands does not show adrenal adenoma or hyperplasia, and adrenal venous sampling indicates increased aldosterone secretion from both adrenal glands. Which of the following is the best next step in management?