Key result
Targeted primary aldosteronism management achieves ~78% complete biochemical response with MRA therapy.
Why the study?
Primary aldosteronism is an underdiagnosed cause of secondary hypertension, and the sustained impact of a dedicated Endocrine Hypertension Service over a subsequent 3-year period needed evaluation.
Does a dedicated Endocrine Hypertension Service sustain primary aldosteronism referral growth, timely diagnosis, and high 12-month biochemical and clinical treatment response rates over a 3-year period including COVID-19 disruptions?
Cohort (n=457)
No
Does a dedicated Endocrine Hypertension Service sustain primary aldosteronism referral growth, timely diagnosis, and high 12-month biochemical and clinical treatment response rates over a 3-year period including COVID-19 disruptions?
A dedicated multidisciplinary Endocrine Hypertension Service achieved sustained growth in primary care and cardiology referrals, earlier detection of primary aldosteronism, and high 12-month biochemical and clinical response rates despite COVID-19 disruptions.
Observed response rates support targeted PA management in dedicated services; leaves open whether multidisciplinary models improve outcomes versus standard care.
AIMS: To evaluate the sustained impact of the Endocrine Hypertension Service on primary aldosteronism (PA) diagnosis and management over a subsequent 3-year period. BACKGROUND: PA is a prevalent yet underdiagnosed cause of secondary hypertension, associated with increased cardiovascular, renal and metabolic risk. Limited awareness, resources and expertise contribute to delays in diagnosis and treatment. A dedicated Endocrine Hypertension Service previously improved PA screening and increased primary care referrals in its first 3 years (2016-2019). METHODS: We conducted a retrospective analysis of consecutive new patients seen at a tertiary Endocrine Hypertension Service in Victoria, Australia, from 1 July 2019 to 30 June 2022, including significant COVID-19 disruptions. Clinical data were analysed by referral year (Y1: 2019/2020, Y2: 2020/2021, Y3: 2021/2022) to assess changes over time. RESULTS: A total of 457 new patients were assessed, with referrals increasing over time (Y1: 115; Y2: 156; Y3: 186). Most referrals originated from primary care (50%), followed by cardiology (23%). At presentation, 20% of patients were treatment-naïve, median hypertension duration was 4 years, and 22% had end-organ damage. Of the cohort, 213 had PA, 171 did not, and 73 were 'undetermined' due to incomplete work-up. Among 171 patients with PA treated medically, 78% achieved complete biochemical response and 46% complete clinical response on MRA monotherapy, as defined by the Primary Aldosteronism Medical Outcome (PAMO) criteria. Among 34 patients who underwent unilateral adrenalectomy, 86% achieved complete biochemical response and 39% complete clinical response, according to the Primary Aldosteronism Surgical Outcome (PASO) criteria. CONCLUSION: Growth in referrals, earlier detection and high treatment response rates highlight the sustained effectiveness of a structured pathway for timely PA diagnosis and management, despite COVID-19 disruptions.
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Chow et al. (2026) conducted a cohort in Hypertension evaluated for primary aldosteronism (n=457). Structured Endocrine Hypertension Service pathway (mineralocorticoid receptor antagonist medical therapy or unilateral adrenalectomy) was evaluated on Complete biochemical response at 12 months in medically treated primary aldosteronism patients (PAMO criteria). Targeted primary aldosteronism management achieved 78% complete biochemical and 46% complete clinical response with MRA therapy, and 86% biochemical and 39% clinical response after adrenalectomy.
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