Patients With Resistant Hypertension Rarely Tested for Aldosteronism

Treatment resistant hypertensive patients rarely test for aldosteronism, according to the study published in Annals of Internal Medicine.

Primary aldosteronism is a common cause of secondary hypertension and is highly prevalent among patients with treatment-resistant hypertension.

‘Innovative practices should be introduced to educate healthcare providers about the importance of testing for aldosterone levels among high-risk patients.’
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Primary aldosteronism is associated with a 4- to 12-fold increased risk for adverse cardiovascular events compared with primary hypertension and can be effectively treated with MRAs or surgery.

Although clinical practice guidelines recommend aldosteronism screening for such patients, they may not be followed.

Researchers from the University of Pennsylvania Perelman School of Medicine, Stanford University, and University of Michigan reviewed data from the Veterans Health Administration (VHA) for more than 269,000 veterans with incident apparent treatment-resistant hypertension to evaluate testing rates for primary aldosteronism (plasma aldosterone-renin) and evidence-based hypertension management.

Treatment-resistant hypertension was defined as either 2 blood pressures of at least 140 mm Hg (systolic) or 90 mm Hg (diastolic) at least 1 month apart during use of at least 3 antihypertensive agents (including a diuretic), or hypertension requiring at least 4 antihypertensive classes.

The data showed that fewer than 2% of patients with incident apparent treatment-resistant hypertension underwent guideline-recommended testing for primary aldosteronism. Testing rates ranged from 0% to 6% across medical centers and did not correlate to population size of patients with apparent treatment-resistant hypertension.

Conn´s Syndrome | Primary Hyperaldosteronism - Causes. Symptoms, Diagnosis, Treatment & Prognosis
Conn’s syndrome or primary hyperaldosteronism is a hormonal disorder where there is excess production of aldosterone hormone by the adrenal glands.

Testing also was associated with higher rates of evidence-based treatment with mineralocorticoid receptor antagonist (MRAs) and better longitudinal blood pressure control. Testing rates also did not change meaningfully over nearly 2 decades of follow-up despite an increasing number of guidelines recommending testing for primary aldosteronism in this population.

According to the researchers, these findings suggest an opportunity for the VHA to introduce innovative practices to educate providers about the importance of testing high-risk patients.

Source-Eurekalert