Testing for Primary Aldosteronism Underutilized Following Stroke: A Multicenter Cohort Study

Primary aldosteronism, the most common endocrine cause of hypertension, is associated with an increased risk of stroke compared with essential hypertension. Targeted treatment with mineralocorticoid receptor antagonists, or surgical resection of an aldosterone-producing adrenal adenoma, can effectively reduce blood pressure and mitigate cardiovascular risk. However, despite being a highly modifiable cardiovascular risk factor, primary aldosteronism is grossly underdiagnosed, even in high-risk populations.

We conducted a multicenter retrospective cohort study to assess the frequency of primary aldosteronism testing among patients admitted between January 2019 to January 2020 with stroke or transient ischemic attack. Data, including blood pressure, antihypertensive medication use, serum potassium, and adrenal imaging, were collected from the medical records of patients admitted for stroke or transient ischemic attack at 2 large tertiary hospitals in Victoria, Australia.

Among 400 patients (mean age, 73.9±13.4 years; 42.1% female), 30% (n=120) had a clinical indication for primary aldosteronism testing, yet only 2% (n=8) were tested.

These findings highlight a missed opportunity to identify a treatable cause of hypertension in patients at high risk of recurrent cerebrovascular events. Routine testing for primary aldosteronism in stroke care pathways may improve long-term outcomes through targeted intervention.