Few Adults at Risk for Primary Aldosteronism Get Screened

By Megan Brooks

March 29, 2021

NEW YORK (Reuters Health) - Only 3% of adults at high risk for primary aldosteronism (PA) are screened for the condition, according to a study presented at ENDO 2021, the Endocrine Society's annual meeting.

"Primary aldosteronism causes persistently elevated blood pressure and when untreated for a prolonged period of time, it can cause heart and kidney damage," lead researcher Dr. Seda Grigoryan, of Michigan State University in Lansing, explained during a press briefing.

"Primary aldosteronism is the most common form of secondary endocrine hypertension that is estimated to affect one in 30 adults in America, or about one million people," Dr. Grigoryan said.

According to guidelines, patients with any of the following risk factors should be screened for PA: elevated BP that's uncontrolled with three conventional antihypertensive drugs or controlled with four or more antihypertensive drugs; high BP and low serum potassium (spontaneous or diuretic-induced); high BP and an adrenal gland mass; high BP and sleep apnea; high BP and a family history of early-onset hypertension or stroke at a young age (<40 years); and high BP and a first-degree relative with PA.

But data on PA screening rates are scarce, Dr. Grigoryan said.

To investigate, she and her colleagues reviewed data from more than 11,000 adults who were seen in outpatient clinics between 2010 and 2019 and met criteria for PA screening. They found that only 3% of this high-risk cohort were ever screened for PA.

Compared with adults who were never screened, those who were screened were slightly younger (mean age, 47 vs. 51 years) but screening rates were similar in those younger versus older than age 40.

Screening rates were overall significantly higher in Asian (8.4%) and Black (6.1%) than in white people (2.8%).

Of the different indications for PA screening, the rates were highest in adults with adrenal nodules (35%) and lowest in patients with hypertension and sleep apnea (2%). People with lower serum potassium, chronic kidney disease and cerebrovascular accidents were also more apt to be screened.

PA screening was initiated most often by general internists followed by endocrinologists and rarely by nephrologists or cardiologists, the researchers note in their conference abstract.

Dr. Grigoryan noted that PA is "typically suspected after cardiovascular and renal complications have already developed. Initiatives to encourage PA screening are crucial for preventing cardiovascular and renal morbidity in many patients with hypertension."

Dr. Lawrence Krakoff, a cardiologist at The Mount Sinai Hospital in New York City, told Reuters Health by email, "This report suggests that recognition of PA by many in primary care and medical specialties as a major cause of secondary and potentially curable hypertension is below optimal."

"Especially for younger patients, finding PA can result in the value of preventing future cardiovascular and metabolic disease without the limitations of long-term medication. Education for providers and patients is needed to improve trends in screening for PA," said Dr. Krakoff, who was not involved in the study.

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: https://bit.ly/3cZg4h4 ENDO 2021, the Endocrine Society Annual Meeting, presented March 23, 2021.