546 Hypertension April 2017 by 7-fold in the PA patients when compared with the essential hypertensive patients. Further, during long-term (median 36 months) follow-up, PA patients with greater increases in LV mass had a shorter AF-free survival. 35 Given the lack of prospective studies, the on-going PAPPHY study (Prospective Appraisal of the Prevalence of Primary Aldosteronism in Hypertensive Patients) was undertaken to assess prospectively the prevalence of PA and its subtypes, that is, aldosterone-producing adenoma and idiopathic hyperplasia, in consecutive hypertensive patients referred for evaluation of AF. 36 The hypothesis that AF is a common clinical presentation of PA is important from the practical standpoint; if verified, it would provide compelling evidence for a role for HT and hyperaldosteronism in the multitude of patients with AF. These patients may have underlying heart disease, but no other obvious cause for the arrhythmia. Currently, they only receive antihypertensive treatment and, if they have a CHA2DS2VASc (congestive heart failure, hypertension, age≥ 75 [doubled], diabetes mellitus, stroke [doubled], vascular disease, age 65–74, and female sex) score of≥ 2 or≥ 3 in males and females, respectively, life-long anticoagulation along with drugs aimed at achieving rate control or restoring and maintaining sinus rhythm. 1 All these measures impose a burden on the healthcare systems and on the patients’ quality of life. The demonstration that PA is a cause of AF in hypertensive patients might eventually change clinical practice in this field in that it may lead to systematic screening for PA. This is important because PA involves> 11% of the hypertensive patients referred to specialized centers, and surgical cure can be achieved in over 50% of PA patients. 30 Moreover, cure of PA by surgery or treatment with MR blockade not only regresses LVH35 but can even restore sinus rhythm as suggested in a long-term study. 35