Key points are not available for this paper at this time.
Abstract The Endocrine Society (ES) guidelines recommend screening for primary aldosteronism (PA) in high risk hypertensive patients presenting with at least one of seven criteria (resistant HTN, hypokalemia, adrenal nodule etc.). Although guidelines are clear and screening is simple, compliance rates among clinicians are extremely low. This results in underdiagnosis of early disease, leading to cadiovasculaer complications and extra-burden of advanced chronic kidney disease. We aimed to evaluate the screening rates in the Nephrology and Hypertension clinics at Assuta Ashdod University Hospital, Israel. Data on adult hypertensive patients was retrieved during January 2018 to December 2020. Included in the study were hypertensive patients who had at least one of the ES criteria for PA screening. Of all suitable patients, we compared those who were screened for PA to patients who were not screened. Univariate and multivariate cox regression analysis were used for comparison between groups. Of 661 patients with HTN, 218 patients (33%) met the ES guidelines for PA screening. Forty-six of them (21.1%), were referred for screening. Advanced age and male gender were associated with lower screening referral rates. Odds ratio for age was 0.945 for every year (95% CI 0.915-0.975). There was a trend towards decreased referral rate in advanced kidney disease. A 21% screening rate, suggests that many cases of PA are likely missed, more often in older patients.We therefore advocate for PA screening of all hypertensive patients, especially elderly patients with CKD, in whom clinicians’ awareness is low but the absolute risk is high.
Korman et al. (Tue,) studied this question.