**3. Genetic Counselling**

To date, the identification of genetic variants that predispose to hypertension in African Americans has not enabled genetic diagnosis and early identification of patients and their at-risk family members. Thus, genetic testing is not currently routine in clinical practice. Indeed, with the exception of *ARMC5* and *CACNA1D* (as outlined above), the other genes discussed in this review have no current clinical implications for the management of hypertension in African Americans. When a clinician encounters a patient with a pathogenic and damaging *ARMC5* variant, screening for Cushing syndrome and primary aldosteronism is encouraged. From our experience, *ARMC5*-related adrenal pathology does not clinically present in early childhood. *ARMC5*-related endocrine hypertension diseases typically develop in adulthood as either subclinical Cushing syndrome, with or without primary aldosteronism, or overt Cushing syndrome. Carriers may not show signs of these conditions until later in adulthood, typically over 40 years of age. Genetic testing and counselling of family members should be considered as the conditions associated with *ARMC5* follow an autosomal dominant inheritance pattern with decreased penetrance.
