Introduction: Primary hyperaldosteronism (PA) is a treatable, frequently underdiagnosed cause of secondary hypertension. We sought to characterize a target population for an intervention to increase appropriate screening for PA, with the hypothesis that a significant proportion of adults with hypertension meet criteria for PA screening. Methods: This was a retrospective cohort study of adults seen in Family Medicine, Nephrology, Cardiology, Internal Medicine, and Endocrinology clinics at our institution from 1/1/2023 to 6/30/2024, age 18-85 with hypertension, without End-Stage Renal Disease (ESRD), who had at least one screening criteria for PA: 4+ hypertension medications, age < 35, adrenal neoplasm, or hypokalemia. Descriptive analysis was performed with frequency distributions. Univariate and multivariable logistic regression analyses were conducted to investigate PA screening by sociodemographic factors and PA risk factors. Results: From a total of 40,662 adults who had hypertension without ESRD, 8,048 (19.8%) met at least 1 criteria for PA screening. Of the 8,048 patients who met criteria, 1,181 patients (14.67%) were under the age of 35, while 4,768 (59.24%) were prescribed 4+ antihypertensive medications, 820 (10.19%) had their most recent serum potassium level below normal, 2,140 (26.59%) had a diagnosis of hypokalemia, and 194 (2.41%) had a diagnosis of adrenal neoplasm. Only 394 (4.90%) had a documented aldosterone/renin ratio result. On multivariable logistic regression analysis, being seen in Endocrinology (Odds Ratio OR: 2.32, 95% CI: 1.67-3.22) or Nephrology (OR: 2.62, 95% CI: 1.43-4.80) compared to Family Medicine; 4+ hypertension medications (OR: 1.77, 95% CI: 1.28-2.45); hypokalemia diagnosis (OR: 2.03, 95% CI: 1.49-2.77); adrenal neoplasm (OR: 21.44, 95% CI: 14.38-31.95); and age <35 (OR: 2.61, 95% CI: 1.76-3.88) were significantly associated with PA screening completion. Patients with Medicare were less likely to have PA screening (OR: 0.62, 95% CI: 0.40-0.97) compared to those with Medicaid. Gender, race, and ethnicity were not associated with differences in PA screening. Conclusions: Despite a substantial number of at-risk patients, only 5% have undergone PA screening. The high prevalence of patients on 4+ antihypertensive medications and those with hypokalemia suggest a significant burden of undiagnosed PA among patients with hypertension.
Nesby et al. (Mon,) studied this question.