The 48 (38%) of 126 PATHWAY-2 substudy patients who had a ratio greater than the published threshold13 of 5·3 (mmol L−1)−1 is similar to the proportion of unselected patients with hypertension who have an apparently normal ARR but develop acute hyperaldosteronism on stress (eg, treadmill test) or ultra-low dose (30 ng) of adrenocorticotropic hormone.31 Here, POMC is linked to Hypertension.