Screening Rate for Primary Aldosteronism Among Patients With Apparent Treatment-Resistant Hypertension: Retrospective Analysis of Current Practice

Abstract

ObjectivePrimary aldosteronism (PA) is the most common secondary cause of hypertension. Patients with PA experience significant cardiovascular and other complications compared with patients with primary hypertension with the same degree of blood pressure control as those with PA. Guidelines have recommended screening all patients with resistant hypertension for PA. The objective of this study was to assess the screening rate for PA among patients with apparent treatment-resistant hypertension and determine the rate of positive screening test result among the group screened. MethodsThis was a retrospective chart review of electronic medical record data of all patients with hypertension aged ≥18 years within a single health system in Minnesota from September 2018 to September 2020. ResultsOf 140 734 patients who were aged ≥18 years and had a diagnosis of hypertension, 18 908 (13.4%) met the criteria for apparent treatment-resistant hypertension after those with congestive heart failure were excluded. Only 795 (4.2%) patients with apparent treatment-resistant hypertension underwent screening for PA in our cohort. Of the 795 patients who underwent screening for PA, 134 (16.9%) had a positive screening test result. ConclusionThe screening rate for PA among patients with resistant hypertension was low. Clinical and public health strategies directed at improving the screening rate for PA are vital.