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Keeping primary aldosteronism in mind: Deficiencies in screening at-risk hypertensives

Brian C Ruhle1, Michael G White1, Salman Alsafran1

  • 1Department of Surgery, Section of Endocrine Surgery, University of Chicago, Chicago, IL.

Surgery
|November 13, 2018
PubMed

Insights

Screening for primary aldosteronism in high-risk hypertensive patients remains low, with only 2.7% of those with hypokalemia and 3.0% with sleep apnea tested. Improved guideline adherence could increase detection rates.

Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Internal Medicine

Background:

  • Primary aldosteronism is an underdiagnosed cause of hypertension with significant morbidity.
  • Early diagnosis and treatment can lead to potential cure and reversal of target organ damage.
  • Hypertensive patients with hypokalemia or sleep apnea are considered high-risk for primary aldosteronism.

Purpose of the Study:

  • To evaluate the screening rates of primary aldosteronism in high-risk hypertensive patient groups.
  • To identify factors influencing the investigation of primary aldosteronism in these populations.

Main Methods:

  • Retrospective review of electronic health records for patients aged 18+ with hypertension and hypokalemia or sleep apnea.
  • Analysis of aldosterone or renin measurement as indicators of screening.
  • Development of regression models to identify explanatory variables for screening.

Main Results:

  • Only 2.7% of nearly 37,000 hypertensive patients with hypokalemia were screened for primary aldosteronism.
  • Screening rates were lower during inpatient hospitalizations compared to clinic visits.
  • 3.0% of hypertensive patients with sleep apnea were screened following guideline inclusion.

Conclusions:

  • Current screening rates for primary aldosteronism in high-risk groups are low.
  • Enhanced adherence to practice guidelines by physicians is crucial for improving case detection.
  • Specialty society support can drive the adoption of guidelines to identify more patients.
Abstract

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