Elderly men are underscreened for primary aldosteronism even in Hypertension Excellence Centre.

ABSTRACT

Purpose The Endocrine Society (ES) guidelines recommend screening for primary aldosteronism (PA) in high risk hypertensive patients presenting with at least one of seven criteria (resistant HTN, hypokalaemia, adrenal nodule, etc.) Although guidelines are clear and screening is simple, compliance rates among clinicians are extremely low. This results in underdiagnosis of early disease, leading to cadiovasculaer complications and the extra-burden of advanced chronic kidney disease. We aimed to evaluate the screening rates in our Nephrology and Hypertension clinics, as an example of a dedicated Hypertension Excellence Centre. Materials and methods Data on adult hypertensive patients was retrieved from January 2018 to December 2020. Included in the study were hypertensive patients who had at least one of the ES criteria for PA screening. Of all suitable patients, we compared those who were screened for PA to patients who were not screened. Univariate and multivariate cox regression analyses were used for comparison between groups. Results Of 661 patients with HTN, 218 patients (33%) met the ES guidelines for PA screening. Forty-six of them (21.1%) were referred for screening. Advanced age and male gender were associated with lower screening referral rates. Odds ratio for age was 0.945 for every year (95% CI 0.915 - 0.975). There was a trend towards decreased referral rate in advanced kidney disease. Conclusions A 21% screening rate, suggests that many cases of PA are likely missed, more often in older patients. We therefore advocate for PA screening of all hypertensive patients, especially elderly patients with CKD, in whom clinicians' awareness is low but the absolute risk is high.

Aldosterone is a hormone secreted from the adrenal gland.Oversecretion of aldosterone (Primary Aldosteronism [PA]) causes salt retention, urinary loss of potassium and difficult to control hypertension.Both hypertension and hyperaldosteronism act synergistically and cause, over time, severe cardiac, vascular and renal damage.Different guidelines support doctors' decision-making algorithm, suggesting who should be evaluated for aldosterone hypersecretion.Our study demonstrates that even in an expert hypertension centre, many candidates for screening are missed. Elderly men are specifically underscreened.Since PA is not as rare as once thought, and can have a devastating impact on patients' health, we suggest screening all hypertensive patients for autonomous hypersecretion of aldosterone.