What evaluation do you do in patients with hypertension and persistently elevated aldosterone/renin ratio (over 20) but without an elevated aldosterone level (under 10 ng/dL)?

Patients with proven primary aldosteronism (based on pathology and postop aldosterone levels) can have plasma aldosterone levels <10 ng/dL. Repeating the levels, especially after optimizing their medications, can improve the test's sensitivity. The key in such cases is a PRA level <1 ng/dL. In the a...