Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities
Background Primary aldosteronism (PA) is a common but under‐recognized cause of secondary hypertension. Data directly comparing screening rates across single and overlapping indications are lacking. Methods and Results We conducted a retrospective review of adults with hypertension seen in outpatien...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.025952 |
| _version_ | 1828046272838238208 |
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| author | Adina F. Turcu Winnie Nhan Seda Grigoryan Lei Zhang Caitlin Urban Haiping Liu Lynn Holevinski Lili Zhao |
| author_facet | Adina F. Turcu Winnie Nhan Seda Grigoryan Lei Zhang Caitlin Urban Haiping Liu Lynn Holevinski Lili Zhao |
| author_sort | Adina F. Turcu |
| collection | DOAJ |
| description | Background Primary aldosteronism (PA) is a common but under‐recognized cause of secondary hypertension. Data directly comparing screening rates across single and overlapping indications are lacking. Methods and Results We conducted a retrospective review of adults with hypertension seen in outpatient clinics at a tertiary referral academic center between January 1, 2017, and June 30, 2020. We included patients with hypertension plus at least one of the following: resistant hypertension; age<35 years; obstructive sleep apnea; hypokalemia; or an adrenal mass. We excluded patients with adrenal insufficiency, severe renal disease, or heart failure, and renovascular hypertension. Of 203 535 patients with hypertension, 86044 (42.3%) met at least 1 PA screening criterion, and of these, 2898 (3.4%) were screened for PA. Screening occurred in 2.7% of patients with resistant hypertension; 4.2% of those with obstructive sleep apnea; 5.1% of those <35 years; 10.0% of those with hypokalemia; and 47.3% of patients with an adrenal mass. Screening rates were higher in patients with multiple risk factors: 16.8% for ≥3, 5.7% for 2, and 2.5% for 1 criterion. Multiple logistic regression showed that the odds of PA screening were higher in patients with hypokalemia: odds ratio (95% CI): 3.0 (2.7–3.3); women: 1.3 (1.2–1.4); Black versus White: 1.5 (1.4–1.7); those with obstructive sleep apnea, chronic renal disease, stroke, and dyslipidemia. Conclusions Consideration for PA is given in a small subset of at‐risk patients, and typically after comorbidities have developed. |
| first_indexed | 2024-04-10T18:24:23Z |
| format | Article |
| id | doaj.art-48efe3c07ce14097bd05ce06ab435c66 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T18:24:23Z |
| publishDate | 2022-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-48efe3c07ce14097bd05ce06ab435c662023-02-02T06:20:21ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-07-01111410.1161/JAHA.122.025952Primary Aldosteronism Screening Rates Differ with Sex, Race, and ComorbiditiesAdina F. Turcu0Winnie Nhan1Seda Grigoryan2Lei Zhang3Caitlin Urban4Haiping Liu5Lynn Holevinski6Lili Zhao7Division of Metabolism, Endocrinology, and Diabetes University of Michigan Ann Arbor MIDivision of Metabolism, Endocrinology, and Diabetes University of Michigan Ann Arbor MIDivision of Metabolism, Endocrinology, and Diabetes University of Michigan Ann Arbor MISchool of Public Health University of Michigan Ann Arbor MIMichigan State University College of Human Medicine East Lansing MIDivision of Metabolism, Endocrinology, and Diabetes University of Michigan Ann Arbor MIUniversity of Michigan Medical School, Data Office for Clinical and Translational Research Ann Arbor MISchool of Public Health University of Michigan Ann Arbor MIBackground Primary aldosteronism (PA) is a common but under‐recognized cause of secondary hypertension. Data directly comparing screening rates across single and overlapping indications are lacking. Methods and Results We conducted a retrospective review of adults with hypertension seen in outpatient clinics at a tertiary referral academic center between January 1, 2017, and June 30, 2020. We included patients with hypertension plus at least one of the following: resistant hypertension; age<35 years; obstructive sleep apnea; hypokalemia; or an adrenal mass. We excluded patients with adrenal insufficiency, severe renal disease, or heart failure, and renovascular hypertension. Of 203 535 patients with hypertension, 86044 (42.3%) met at least 1 PA screening criterion, and of these, 2898 (3.4%) were screened for PA. Screening occurred in 2.7% of patients with resistant hypertension; 4.2% of those with obstructive sleep apnea; 5.1% of those <35 years; 10.0% of those with hypokalemia; and 47.3% of patients with an adrenal mass. Screening rates were higher in patients with multiple risk factors: 16.8% for ≥3, 5.7% for 2, and 2.5% for 1 criterion. Multiple logistic regression showed that the odds of PA screening were higher in patients with hypokalemia: odds ratio (95% CI): 3.0 (2.7–3.3); women: 1.3 (1.2–1.4); Black versus White: 1.5 (1.4–1.7); those with obstructive sleep apnea, chronic renal disease, stroke, and dyslipidemia. Conclusions Consideration for PA is given in a small subset of at‐risk patients, and typically after comorbidities have developed.https://www.ahajournals.org/doi/10.1161/JAHA.122.025952adrenal massaldosteronehypertensionhypokalemiaprimary aldosteronismrenin |
| spellingShingle | Adina F. Turcu Winnie Nhan Seda Grigoryan Lei Zhang Caitlin Urban Haiping Liu Lynn Holevinski Lili Zhao Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease adrenal mass aldosterone hypertension hypokalemia primary aldosteronism renin |
| title | Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities |
| title_full | Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities |
| title_fullStr | Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities |
| title_full_unstemmed | Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities |
| title_short | Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities |
| title_sort | primary aldosteronism screening rates differ with sex race and comorbidities |
| topic | adrenal mass aldosterone hypertension hypokalemia primary aldosteronism renin |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.025952 |
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