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The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...

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A Novel Method: Super-selective Adrenal Venous Sampling

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Published on: September 15, 2017

Nationwide, Pragmatic, Direct-to-Patient Primary Aldosteronism Testing Program.

Jenifer M Brown^1,2,3, Laura C Tsai^1,3, Eva E Abel^1,2,3

¹Division of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.

Hypertension (Dallas, Tex. : 1979)

|February 21, 2025

Summary

Direct-to-patient testing effectively identifies primary aldosteronism, a condition linked to hypertension and cardiovascular risk. This pragmatic approach increases diagnoses and treatment initiation, improving patient outcomes.

Keywords:

aldosterone blood pressure hyperaldosteronism hypertension social media

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Area of Science:

Endocrinology
Cardiovascular Medicine
Hypertension Management

Background:

Primary aldosteronism affects 10-25% of hypertensive patients, increasing cardiovascular risk.
Aldosterone-directed therapy mitigates this risk, yet screening rates remain low (2%).
Clinical inertia hinders timely diagnosis and treatment of primary aldosteronism.

Purpose of the Study:

To bypass clinical inertia in primary aldosteronism diagnosis.
To identify individuals with primary aldosteronism using direct-to-patient testing.
To evaluate the feasibility and scalability of pragmatic diagnostic approaches.

Main Methods:

Recruited hypertensive adults via online platforms with virtual consent.
Utilized local phlebotomy for sample collection.
Employed a standardized diagnostic algorithm with results communicated to patients and providers.

Main Results:

25.4% of 694 participants tested positive for primary aldosteronism.
Common indications included sleep apnea, resistant hypertension, and hypokalemia.
Despite specialist care, 57% of participants had not been previously tested.

Conclusions:

Pragmatic, direct-to-patient testing increases primary aldosteronism diagnoses.
Simplified interpretation and results delivery enhance treatment implementation.
Scalable approaches are crucial for meeting new screening guidelines for all hypertensive individuals.