Key result
Primary aldosteronism screening reaches just 0.7% of hypertensive adults, leaving expected cases largely undiagnosed.
Why the study?
Primary aldosteronism is a common cause of secondary hypertension that remains largely unrecognized and untreated, and the impact of a specialized clinic on evaluation and treatment rates was unknown.
Cohort (n=1,100,000)
Less than 1% of hypertensive patients expected to have primary aldosteronism are formally diagnosed and treated, highlighting a significant care gap that specialized clinics may help close.
Underdiagnosis of primary aldosteronism persists in hypertension; observational data leaves open whether specialized clinics meaningfully increase screening and targeted treatment.
Importance: Primary aldosteronism (PA) is one of the most common causes of secondary hypertension but remains largely unrecognized and untreated. Objective: To understand the outcomes of a specialized clinic on rates of evaluation and treatment of PA in the context of secondary factors. Design, Setting, and Participants: This population-based cohort study was conducted in Alberta, Canada, using linked administrative data between April 1, 2012, and July 31, 2019, on adults identified as having hypertension. Main Outcomes and Measures: We evaluated each step of the diagnostic and care pathway for PA to determine the proportion of people with hypertension who received screening, subtyping, and targeted treatment for PA. Variations in diagnosis and treatment were examined according to individual-level, clinician-level, and system-level characteristics. Results: Of the 1.1 million adults with hypertension, 7941 people (0.7%) were screened for PA. Among those who were screened, 1703 (21.4%) had positive test results consistent with possible PA, and 1005 (59.0%) of these were further investigated to distinguish between unilateral and bilateral forms of PA. Only 731 individuals (42.9%) with a positive screen result received disease-targeted treatment. Geographic zones and clinician specialty were the strongest determinants of screening, subtyping, and treatment of PA, with the highest rates corresponding to the location of the provincial endocrine hypertension program. Conclusions and Relevance: In this cohort, less than 1% of patients expected to have PA were ever formally diagnosed and treated. These findings suggest that a system-level approach to assist with investigation and treatment of PA may be highly effective in closing care gaps and improving clinical outcomes.
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Liu et al. (2021) conducted a cohort in Primary Aldosteronism and Hypertension (n=1,100,000). Specialized clinic was evaluated on Proportion of people with hypertension who received screening, subtyping, and targeted treatment for primary aldosteronism. Screening for primary aldosteronism was performed in only 0.7% of 1.1 million adults with hypertension, resulting in less than 1% of expected cases being formally diagnosed and treated.
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