https://www.eurekalert.org/pub_releases/2020-12/acop-drp122220.php
News Release 28-Dec-2020
American College of Physicians
1. Despite recommendations, patients with treatment-resistant hypertension rarely tested for primary aldosteronism
Abstract: https://www.acpjournals.org/doi/10.7326/M20-4873
URL goes live when the embargo lifts
A retrospective cohort study found that testing for primary aldosteronism in patients with treatment-resistent hypertension was rare and also associated with higher rates of evidence-based treatment and better longitudinal blood pressure control. The findings are published in Annals of Internal Medicine.
Primary aldosteronism is a common cause of secondary hypertension and is highly prevalent among patients with treatment-resistant hypertension. Primary aldosteronism is associated with a 4- to 12-fold increased risk for adverse cardiovascular events compared with primary hypertension and can be effectively treated with MRAs or surgery. Although clinical practice guidelines recommend aldosteronism screening for such patients, they may not be followed.
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The data showed that fewer than 2% of patients with incident apparent treatment-resistant hypertension underwent guideline-recommended testing for primary aldosteronism. Testing rates ranged from 0% to 6% across medical centers and did not correlate to population size of patients with apparent treatment-resistant hypertension. Testing also was associated with higher rates of evidence-based treatment with mineralocorticoid receptor antagonist (MRAs) and better longitudinal blood pressure control. Testing rates also did not change meaningfully over nearly 2 decades of follow-up despite an increasing number of guidelines recommending testing for primary aldosteronism in this population. According to the researchers, these findings suggest an opportunity for the VHA to introduce innovative practices to educate providers about the importance of testing high-risk patients.
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