Title

Despite Recommendations, Patients With Treatment-Resistant Hypertension Rarely Tested for Primary Aldosteronism
December 29, 2020

A retrospective cohort study published in the Annals of Internal Medicine found that testing for primary aldosteronism in patients with treatment-resistant hypertension was rare.

“The findings reinforce prior observations of low adherence to guideline-recommended practices in smaller health systems and underscore the urgent need for improved management of patients with treatment-resistant hypertension,” wrote Jordana B. Cohen, MD, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, and colleagues.

The researchers examined 269,010 veterans with apparent treatment-resistant hypertension from 2000 to 2017. Treatment-resistant hypertension was defined as either 2 blood pressures (BPs) of at least 140 mm Hg or 90 mm Hg at least 1 month apart during use of 3 antihypertensive agents (including a diuretic), or hypertension requiring 4 antihypertensive classes.

The data showed that fewer than 2% of patients with incident apparent treatment-resistant hypertension underwent guideline-recommended testing for primary aldosteronism. Testing rates ranged from 0% to 6% across medical centres and did not correlate to population size of patients with apparent treatment-resistant hypertension.

An index visit with a nephrologist or an endocrinologist was associated with a higher likelihood of testing compared with primary care, and testing was associated with a 4-fold higher likelihood of initiating mineralocorticoid receptor antagonist (MRA) therapy and with better BP control over time.

Testing rates also did not change meaningfully over nearly 2 decades of follow-up despite an increasing number of guidelines recommending testing for primary aldosteronism in this population.

Reference: https://www.acpjournals.org/doi/10.7326/M20-4873

SOURCE: American College of Physicians