Few patients at risk for common high blood pressure disorder receive screening

Only 3% of patients at high risk for primary aldosteronism (PA), a common disorder that causes high blood pressure and can lead to heart and kidney complications, are screened for the condition, according to a study that will be presented virtually at ENDO 2021, the Endocrine Society’s annual meeting.

“The results of our study indicate that initiatives to encourage PA screening are crucial for preventing cardiovascular and kidney disease in many patients with hypertension,” said lead researcher Seda Grigoryan, M.D., of Michigan State University in Lansing, Mich.

PA is the most common form of secondary hypertension—high blood pressure caused by another disease. Nearly half of adults in the United States have high blood pressure. PA occurs when the adrenal glands produce too much aldosterone, the hormone responsible for balancing potassium and sodium in the body. Overproduction of aldosterone causes the body to retain more sodium and lose potassium. This leads to elevated blood pressure, increasing the risk of heart and kidney disease.

Patients with PA have a higher risk of developing cardiovascular and kidney complications compared with patients with primary hypertension (high blood pressure without an apparent cause) with similar blood pressure.

The researchers reviewed data for adult patients with hypertension seen in outpatient clinics between 2010 and 2019 who were known to be at risk for PA. Of 11,627 patients, only 3% were ever screened for PA. Risk factors included hypertension resistant to treatment, hypertension below age 40, hypertension and obstructive sleep apnea, hypertension and potassium deficiency, and hypertension and a mass in the adrenal gland.

Patients who were screened generally were younger, and Black patients were more likely to be screened than those of other races. Grigoryan found the diagnosis of PA was suspected more often after complications—such as strokes and kidney disease—had already developed. Of the patients at risk for PA, screening was done most often in those with adrenal nodules (35%) and least often in those with sleep apnea (2%).