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Screening for Primary Aldosteronism in Resistant Hypertension
27 Pages Posted: 16 Aug 2018
More...Abstract
Background: Resistant hypertension is associated with higher rates of cardiovascular disease, kidney disease, and death than essential hypertension. Although clinical practice guidelines recommend screening for primary aldosteronism among persons with resistant hypertension, rates of screening are unknown.
Methods: We performed a cohort study in an academic health system using an electronic health registry to identify persons with resistant hypertension. We identified 145,670 persons with hypertension and excluded persons with congestive heart failure or advanced chronic kidney disease. We identified persons with resistant hypertension by conventional definitions. We determined screening rates for primary aldosteronism and demographic and clinical characteristics associated with screening.
Findings: Among 5641 persons with resistant hypertension, 111 (2·0%) were screened for primary aldosteronism. Screened persons were younger (56·2 /- 13·0 years vs. 65·6 /- 11·6 years; p<·0001), and had higher diastolic blood pressure (81·9 /- 14·2 mmHg vs. 74·7 /- 13·6 mmHg; p<·0001), lower serum potassium concentrations (3·9 /- 0·6 mmol/L vs. 4·1 /- 0·5 mmol/L; p=0·01), and lower rates of diagnosed coronary artery disease (14·0% vs. 7·2%; p=0·04) than unscreened persons. Screened persons had significantly higher rates of prescription for calcium channel blockers, mixed alpha/beta adrenergic receptor antagonists, loop diuretics, sympatholytics, and vasodilators and lower rates of prescription of thiazide and thiazide-type diuretics (p=0·049). The prescription of mineralocorticoid receptor antagonists or other potassium sparing diuretics was not significantly different between groups (p=0·33).
Interpretation: Patients with resistant hypertension are infrequently screened for primary aldosteronism. Efforts to highlight guideline-recommended screening and/or targeted therapy are warranted.
Funding: Department of Medicine, Stanford University School of Medicine; National Institutes of Health.
Conflict of Interests: The authors have no conflicts of interest to disclose.
Ethical Approval Statement: The Institutional Review Board at Stanford University approved the study protocol, including a waiver of informed consent for this study.
Suggested Citation: Suggested Citation