In a recent study, Jordana B. Cohen, M.D., MSCE, and colleagues have reported low adherence to guideline-recommended practices for primary aldosteronism testing among smaller health systems which reinforces the prior awareness. The research findings have been published in the journal Annals of Internal Medicine on 29 December 2020.
Primary aldosteronism is a common cause of secondary hypertension and treatment-resistant hypertension. Treatment with adrenalectomy or mineralocorticoid receptor-blockers can prevent long-term adverse outcomes. Testing practices for primary aldosteronism, remained inadequate over nearly 2 decades, according to a large study of Veterans Health Administration data. Researchers conducted a study among U.S veterans to evaluate testing rates for primary aldosteronism and evidence-based hypertension management in patients with treatment-resistant hypertension.
It was a retrospective cohort study assessing 269 010 Veterans with apparent treatment-resistant hypertension from 2000 to 2017, defined as either 2 blood pressures (BPs) of at least 140 mm Hg (systolic) or 90 mm Hg (diastolic) at least 1 month apart during the use of 3 antihypertensive agents (including a diuretic), or hypertension requiring 4 antihypertensive classes. The primary endpoint assessed was testing for primary aldosteronism. Researchers also evaluated the initiation of mineralocorticoid receptor antagonists (MRA) treatment and change in systolic blood pressure over time.
Key findings of the study were:
• Among 269 010 patients, researchers identified 4277 (1.6%) patients who were tested for primary aldosteronism.
• They noted, Veterans were more likely to be tested for primary aldosteronism if they had a consultation with nephrologists (HR 2.05) or endocrinologists (HR 2.48) when compared with primary care (cardiologists).
• They reported testing was associated with a 4-fold higher likelihood of initiating MRA therapy (HR, 4.10) and with better BP control over time.
• Overall, the researchers observed less than 2% of patients with incident apparent treatment-resistant hypertension underwent guideline-recommended testing for primary aldosteronism.
The authors concluded, "In a nationally distributed cohort of veterans with apparent treatment-resistant hypertension, testing for primary aldosteronism was rare and was associated with higher rates of evidence-based treatment with MRAs and better longitudinal BP control".
They further added, "The findings reinforce prior observations of low adherence to guideline-recommended practices in smaller health systems and underscore the urgent need for improved management of patients with treatment-resistant hypertension".
For further information:
https://www.acpjournals.org/doi/full/10.7326/M20-4873