Primary aldosteronism (PA) is a frequent cause of secondary hypertension. Studies on the prevalence of PA are lacking in the Middle East region. To determine the proportion of patients with high aldosterone-to-renin ratio (ARR) among Lebanese patients with hypertension screened for PA and to compare their clinical and biological characteristics with patients with essential hypertension. A retrospective review of medical charts of patients with hypertension undergoing sampling of serum aldosterone and plasma renin concentration at a tertiary care center between October 2022 and 2023 was conducted. Of 144 patients with hypertension screened for PA, 23 (16%) had an ARR higher than 3.7 ng/dL/mU/L and serum aldosterone above 15 ng/dL. The mean age of the screened population was 51 ± 15 years, 56% were men. The median duration of hypertension was 4 years and the median number was 2 of antihypertensive medications. Patients with a positive screening test were mostly men (88%, P = .0001), and more frequently had diabetes (50%, P < .0001) than those with essential hypertension. Only 22% had hypokalemia. Of the 23 patients, 11 underwent intravenous saline suppression testing; PA was confirmed in all of them. The high frequency of PA in our center is comparable to other countries. More studies are needed to determine how to reduce healthcare disparities and overcome the barriers to appropriate diagnosis and treatment.