Why the study?
Does therapeutic drug monitoring-guided primary aldosteronism screening reduce costs and improve diagnostic yield in patients with treatment-resistant hypertension?
Does therapeutic drug monitoring-guided primary aldosteronism screening reduce costs and improve diagnostic yield in patients with treatment-resistant hypertension?
Therapeutic drug monitoring-guided screening for primary aldosteronism in treatment-resistant hypertension is a cost-saving strategy that effectively identifies adherent patients who have a higher prevalence of the disease.
Primary aldosteronism (PA) is present in up to 20% of patients with treatment-resistant hypertension (TRH). Investigation for PA in patients with TRH is recommended by current guidelines after medication nonadherence is excluded. Studies using therapeutic drug monitoring (TDM) have shown that >50% of patients with TRH are nonadherent to their prescribed antihypertensive medications. However, the relationship between the prevalence of PA and medication adherence as confirmed by TDM has not been previously assessed. A retrospective analysis from a hypertension referral clinic showed that prevalence of PA in adherent patients with TRH by TDM was significantly higher than in nonadherent patients (28% vs 8%, P<.05). Furthermore, cost analysis showed that TDM-guided PA screening was $590.69 less expensive per patient, with minimal impact on the diagnostic accuracy. These data support a TDM-guided PA screening approach as a cost-saving strategy compared with routine PA screening for TRH.
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Velasco et al. (2015) studied this question.
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