Abstract 137: Trends In Primary Aldosteronism Screening - An Underutilized Test In Hypertension

Abstract

Previous studies have shown low screening rates for primary aldosteronism (PA) in at-risk hypertensive (HTN) patients. However, the impact of recent HTN guidelines on screening has not been thoroughly evaluated. Therefore, we retrospectively reviewed adults with new diagnosis of HTN seen in outpatient clinics between 1/1/2015 and 12/31/2020. We included patients with BP ≥140/90 mmHg for 2 consecutive visits or had HTN ICD codes. Patients were categorized into Stage-2 HTN or greater (BP ≥140/90 mmHg) and apparent resistant HTN (aRHTN) defined as uncontrolled BP (≥130/80 mmHg) on 3 anti-HTN drugs including a diuretic or controlled BP on ≥4 drugs based on 2018 ACC/AHA resistant HTN guidelines. A total of 34,384 patients were included with mean age 61±14 years, 53% (18,384) women, 17% (5,693) Black individuals, with 2.5 years of median follow-up. As shown in Figure 1, the PA screening rates over time ranged 1-2% and 4-6% in Stage-2 HTN or greater (A), and aRHTN (B), respectively. Moreover, rates of PA screening index by year were not increased after the launch of the 2018 ACC/AHA guidelines, for both categories. Interestingly, the proportion of PA screening did not change during the COVID-19 pandemic despite the reduction in number of patients seen in 2020. In conclusion, the rate of PA screening has not increased in the hypertensive population even after the guidelines demonstrate the need for screening in these at-risk patients. These findings highlight the underutilization of PA screening and calls for increased awareness of the disease in at-risk populations.