Lack of primary aldosteronism screening was associated with a higher prevalence of left ventricular hypertrophy (64.7% vs 40.5%, P=0.005) and proteinuria (36.4% vs 17.6%, P=0.029).
Observational (n=186)
No
Is lack of primary aldosteronism screening associated with a higher prevalence of cardiac and renal target organ damage in older patients with hypertension?
Primary aldosteronism screening in older hypertensive patients is largely confined to hypertension specialty services, and lack of screening is associated with higher rates of cardiac and renal target organ damage.
Absolute Event Rate: 40.5% vs 64.7%
p-value: p=0.005
Objective: To assess department-level differences in the implementation of primary aldosteronism screening among older patients with hypertension and to examine whether gaps in screening practice are associated with cardiac and renal target organ damage. Design and method: This single-center, retrospective study included patients aged 60 years or older hospitalized with hypertension over a predefined three-month period in 2025. Patients with established causes of secondary hypertension other than primary aldosteronism were excluded. Patients were classified into screened and unscreened groups according to whether the aldosterone-to-renin ratio was measured during hospitalization. Departments were categorized as a hypertension specialty service or non-hypertension services, including endocrinology, neurology, general medicine, cardiology, and nephrology. In this study, the hypertension specialty service was a subspecialty within the cardiology department, and cardiology refers to general cardiology services excluding the hypertension specialty. Target organ damage outcomes included left ventricular hypertrophy assessed by echocardiography and proteinuria assessed by urinalysis. Analyses were conducted using available-case data. Results: A total of 186 older patients with hypertension were included, including 80 managed in the hypertension specialty service and 106 in non-hypertension services. Marked disparities in screening practice were observed across departments, with screening for primary aldosteronism performed far more frequently in the hypertension specialty service than in non-hypertension services (61.3% versus 1.9%, P<0.001). Among patients with available echocardiographic data, left ventricular hypertrophy was more prevalent in the unscreened group than in the screened group (64.7% versus 40.5%, P=0.005). Similarly, among patients with available urinalysis results, proteinuria was more common in the unscreened group (36.4% versus 17.6%, P=0.029). Among patients who underwent aldosterone-to-renin ratio testing, the positivity rate was 49.0%. Conclusions: Primary aldosteronism screening was largely confined to hypertension specialty care and was rarely implemented in non-hypertension departments. These findings highlight a substantial gap between guideline-recommended screening and real-world clinical practice, and lack of screening was associated with a higher prevalence of cardiac and renal target organ damage. Even among patients with clinical features suggestive of primary aldosteronism, recognition and screening remained insufficient outside hypertension specialty services. Targeted strategies are needed to promote systematic screening pathways in non-hypertension departments.
Wang et al. (Fri,) führten eine Beobachtungsstudie in der Hypertonie (n=186) durch. Screening auf primären Aldosteronismus vs. kein Screening wurde hinsichtlich der linken ventrikulären Hypertrophie bewertet (p=0,005). Mangel an Screening für primären Aldosteronismus war mit einer höheren Prävalenz von linker ventrikulärer Hypertrophie (64,7 % vs. 40,5 %, P=0,005) und Proteinurie (36,4 % vs. 17,6 %, P=0,029) assoziiert.