Primary aldosteronism testing ‘crucial’ for high-risk populations
Only 3% of adults at high risk for primary aldosteronism are screened for the condition, typically only after complications have developed, according to data from a retrospective study presented at the ENDO annual meeting.
“Primary aldosteronism is the most common form of endocrine hypertension, estimated to affect 1 in 30 adult Americans,” Adina Turcu, MD, MS, assistant professor of endocrinology and internal medicine at the University of Michigan, told Healio. “Due to direct target organ damage, primary aldosteronism is associated with higher cardiovascular and renal morbidity and mortality than equivalent primary hypertension. Despite this, primary aldosteronism remains underrecognized, and hypertension treatment is generally not customized.”
In a retrospective review, Turcu and colleagues analyzed data from 11,627 adult patients with hypertension seen in outpatient clinics between 2010 and 2019 who had resistant hypertension, hypertension and hypokalemia, hypertension at age younger than 40 years, hypertension and a known adrenal mass, or hypertension and obstructive sleep apnea. Adults with known high-renin hypertension, renovascular hypertension or congenital adrenal hyperplasia were excluded.
Within this high-risk cohort, only 3.27% were ever screened for primary aldosteronism. Those screened were younger (mean age, 48 years vs. 51 years; P < .0001), more often women (55.28% vs. 45.71%; P = .0003), had lower serum potassium (mean, 3.4 vs. 3.7; P < .0001), and were more likely to have chronic kidney disease (29.27% vs. 17.5%; P < .0001) and cerebrovascular accidents (9.21% vs. 6.16%; P = .02) compared with adults who were never screened.
Most patients in the cohort were white (79.9% vs. 15.3% Black or 2.3% Asian), but screening rates were overall higher among Asian adults (8.4%) and Black adults (6.1%) vs. white adults (2.8%; P < .0001). Of the different indications for primary aldosteronism screening, the rates were highest among patients with adrenal nodules (35%) and lowest in patients with hypertension and obstructive sleep apnea (2.1%). The rates of screening were similar among those older vs. younger than 40 years.
Among patients with resistant hypertension, those screened were on average 10 years younger compared with those not screened (mean age, 59 years vs. 69 years; P < .0001) and were twice as likely to be Black (20.7% vs. 10.1%).
No differences by sex, age or race were observed between those screened vs. not screened for primary aldosteronism.
General internists were the most likely to initiate primary aldosteronism screening (53.9%), followed by endocrinologists (15.8%), and rarely by nephrologists (9.5%) or cardiologists (4.2%).
“Patients received screening more often when the clinical index of suspicion was very high and after complications, such as cerebrovascular accidents and chronic renal failure, had developed,” Turcu told Healio. “This underscores a missed opportunity to diagnose and treat a curable form or hypertension and to prevent CV and renal disease.”
The researchers noted that the data indicate that initiatives to encourage more primary aldosteronism screening are “crucial” for preventing CV and renal morbidity in many patients with hypertension.