Is It Possible to Screen for Primary Aldosteronism Effectively in Primary Care?

Area of Science:

• Endocrinology
• Hypertension Management
• Primary Care Medicine

Background:

• Primary aldosteronism (PA) is the most common cause of secondary hypertension.
• Accurate case detection for PA remains a significant clinical challenge.
• Current screening protocols primarily rely on secondary care settings.

Purpose of the Study:

• To evaluate the feasibility and outcomes of PA screening in a primary care setting.
• To compare the effectiveness of primary care-based aldosterone:renin ratio (ARR) testing with secondary care evaluations.
• To assess the diagnostic performance of primary care ARR in identifying PA.

Main Methods:

• Retrospective observational study involving adults screened for PA in Oxford primary care services (2008-2022).
• Analysis of aldosterone:renin ratio (ARR) test results from both primary and secondary care.
• Comparison of ARR correlation, concordance, and predictive performance for PA diagnosis.

Main Results:

• Out of 2915 adults screened, 107 (3.7%) were diagnosed with PA.
• Primary care ARR demonstrated a strong correlation (r=0.841) with secondary care ARR.
• Primary care ARR testing achieved an Area Under the ROC curve of 0.81, with comparable sensitivity to secondary care.
• Beta-blocker use was associated with an increased risk of false-positive ARR results.

Conclusions:

• Screening for PA in primary care using ARR is a viable strategy.
• Primary care ARR testing offers comparable sensitivity to secondary care, facilitating earlier diagnosis.
• Implementing simple referral criteria and enhancing primary care awareness can optimize PA case detection.