Given the continuum nature of PA pathology and hence the arbitrariness and artificial nature of currently used ARR thresholds (positive screening= 20 to 30 ng/dL: ng/mL/hour using PRA for calculation), it may be possibly worthwhile to mark lower ARR thresholds (eg: 11-20 or 16-20; especially with suppressed renin) as pre-primary aldosteronism (akin to prediabetes and prehypertension). This evidence concerns the gene S100A6 and primary aldosteronism.