Study Underlines Low Rates of Screening, Treatment for Primary Aldosteronism

A new study is underlining the immediate need for improvements and initiatives to increase the screening and diagnosis of primary aldosteronism.

Released right on the heels of an ENDO 2021 study suggesting fewer than 5% of high-risk patients underwent screening for the most common form of secondary hypertension, the latest study indicates less than 1% of patients expected to have primary aldosteronism underwent formal diagnosis and treatment.

“Primary aldosteronism is an increasingly recognized public health problem, not only because of the excess risk of cardiovascular disease, but also because of its high prevalence. But only a small fraction of affected patients are ever screened or treated,” wrote investigators. “Improvements may be best realized by increasing awareness of this condition, promoting screening efforts, and providing access to specialized programs that can assist with workup when appropriate.”

Despite a greater emphasis in recent decades on management of hypertensive disorders, most data still indicates dramatically low rates of treatment and screening for primary aldosteronism. The current study was designed as a retrospective, populations-based cohort study by a team from the University of Calgary led by Yuan-Yuan Liu, MD, PhD, with an interest in determining how the implementation of a specialized clinic may impact this trend.

With this in mind, investigators designed their study to assess each step in the diagnostic and care pathway for primary aldosteronism to determine what proportion of patients with hypertension received screening, subtyping, and targeted treatment for primary aldosteronism. Using the Alberta Health database, investigators obtained data related to more than 99% of the 4.3 million residents of Alberta, which included 1.1 million patients with hypertension who underwent screening from April 1, 2012 to July 31, 2019.

For the purpose of analysis, investigators limited their study to insurance beneficiaries 18 and older with prevalent hypertension determined through use of ICD codes.

Upon analysis, investigators discovered just 7941 (0.7%) of the 1.1 million adults with hypertension underwent screening for primary aldosteronism. Among those who underwent screening, 1703 (21.4%) had positive results consistent with possible primary aldosteronism. Ultimately, just 59% of these patients underwent further testing to diagnosis between unilateral and bilateral forms of primary aldosteronism.

In total, just 42.9% of patients with positive screen results went on to receive disease-targeted treatment. Further analysis indicates 94.7% of these patients underwent medical therapy and 16.4% underwent adrenalectomy. Rates of disease-targeted treatment were greatest among endocrinologists (54.5%; 95% CI, 48.3-60.6%) and family medicine practitioners (39.6%; 95% CI, 35.0%-44.3%).

When assessing determinants of screening, investigates found the strongest associations were oinked to geographic zones and clinician specialty. Investigators pointed out the highest rates of screening, subtyping, and treatment of primary aldosteronism were associated with a location of a provincial endocrine hypertension program.

“The implication of our findings is that a system-level approach to simple workup and treatment may be effective in closing care gaps and improving clinical outcomes for patients with PA. With the declining rates of blood pressure control in the US and Canada, proper workup and treatment of secondary causes of hypertension, especially PA, has become more relevant than ever,” wrote investigators.

This study, “Outcomes of a Specialized Clinic on Rates of Investigation and Treatment of Primary Aldosteronism,” was published in JAMA Surgery.