Screening for primary aldosteronism among adults with hypertension and obstructive sleep apnea was exceedingly low, occurring in only 1.2% of the 53,130 eligible patients.
Cohort (n=53,130)
What is the rate of screening for primary aldosteronism among adults with hypertension and obstructive sleep apnea in routine clinical practice?
Despite guideline recommendations, the population-level uptake of screening for primary aldosteronism in patients with hypertension and obstructive sleep apnea is exceedingly low at 1.2%.
BACKGROUND: Hypertension plus obstructive sleep apnea (OSA) is recommended in some guidelines as an indication to screen for primary aldosteronism (PA), yet prior data has brought the validity of this recommendation into question. Given this context, it remains unknown whether this screening recommendation is being implemented into clinical practice. METHODS: We conducted a population-based retrospective cohort study of all adult Ontario (Canada) residents with hypertension plus OSA from 2009 to 2020 with follow-up through 2021 utilizing provincial health administrative data. We measured the proportion of individuals who underwent PA screening via the aldosterone-to-renin ratio by year. We further examined screening rates among patients with hypertension plus OSA by the presence of concurrent hypokalemia and resistant hypertension. Clinical predictors associated with screening were assessed via Cox regression modeling. RESULTS: The study cohort included 53,130 adults with both hypertension and OSA, of which only 634 (1.2%) underwent PA screening. Among patients with hypertension, OSA, and hypokalemia, the proportion of eligible patients screened increased to 2.8%. Among patients ≥65 years with hypertension, OSA, and prescription of ≥4 antihypertensive medications, the proportion of eligible patients screened was 1.8%. Older age was associated with a decreased likelihood of screening while hypokalemia and subspecialty care with internal medicine, cardiology, endocrinology, or nephrology were associated with an increased likelihood of screening. No associations with screening were identified with sex, rural residence, cardiovascular disease, diabetes, or respirology subspecialty care. CONCLUSIONS: The population-level uptake of the guideline recommendation to screen all patients with hypertension plus OSA for PA is exceedingly low.
Hundemer et al. (Fri,) conducted a cohort in Hypertension and obstructive sleep apnea (n=53,130). Screening for primary aldosteronism was evaluated on Proportion of individuals who underwent primary aldosteronism screening. Screening for primary aldosteronism among adults with hypertension and obstructive sleep apnea was exceedingly low, occurring in only 1.2% of the 53,130 eligible patients.