COMMENT & RESPONSEIn Reply We appreciate the perspective from Boulestreau and Couffinhal on our recent initiative to enhance screening for primary aldosteronism (PA) by leveraging electronic health records capabilities. We designed and implemented an advisory that identifies PA screening candidates and assists clinicians with test ordering and interpretation. 1 Boulestreau and Couffinhal suggest empirical use of mineralocorticoid receptor antagonists (MRA) to treat patients with possible PA as a more pragmatic alternative to PA screening.Indeed, MRAs can effectively control blood pressure, and their benefits are amplified when renin is suppressed. 2 However, compelling arguments favor early identification of PA and personalized therapy.So why is empirical treatment with MRAs suboptimal in patients who may have PA? Because to treat PA effectively (that is, to reduce increased risks of cardiovascular events and mortality associated with PA 3 ), MRA treatment must reverse renin suppression. However, empiric MRA doses are often too low to accomplish renin normalization, in part because clinicians do not measure renin to guide empiric MRA dose titration. In addition, MRA dose titration is often limited by hyperkalemia due to kidney insufficiency or other antihypertensives, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers.A definitive diagnosis of PA can also allow for surgery when appropriate. When PA arises from 1 of the 2 adrenal glands, it can be cured with unilateral laparoscopic adrenalectomy resulting in reduced blood pressure, correction of hypokalemia, reduction of medication burden, and improved quality of life. 4 More importantly, surgery is associated with a reduced risk of all-cause mortality and adverse cardiovascular and kidney outcomes not only compared with patients with similar severity of hypertension, but also compared with patients who receive medical therapy for PA. 3,5 Considering the global underrecognition of PA and feasibility, expert opinion has shifted from recommending stringent testing criteria for PA (eg, midmorning blood draw after a minimum 2 hours of being upright and after avoidance of certain medications) to encouraging screening whenever possible. Convenience testing (ie, testing whenever a patient has an office visit, without pretest preparation), could be sufficient for therapy decisions in a large proportion of patients because frank PA is often evident regardless of testing circumstances, and patients with intermediate results could start an MRA trial, aiming for renin normalization, before pursuing further testing.To conclude, empirical treatment with MRA could be an alternative when PA testing and specific treatment are not available; however, as modern medicine evolves toward individualized therapy and when cure is within reach for millions of patients, why should we settle for suboptimal shortcuts?