Primary Aldosteronism Testing Rare for Patients with Resistant Hypertension

By Kelly Young

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Patients with apparent treatment-resistant hypertension are rarely tested for primary aldosteronism, despite guidelines recommending this practice, according to an Annals of Internal Medicine study.

Researchers studied nearly 270,000 veterans with apparent treatment-resistant hypertension — either two blood pressure readings of at least 140 mm Hg for systolic or 90 mm Hg for diastolic at least 1 month apart while using three antihypertensive medications, or treatment with four antihypertensive classes.

During a median 3.3 years' follow-up, only 1.6% of patients with apparent treatment-resistant hypertension were tested for primary aldosteronism. Patients with hypokalemia had higher odds of being tested, but testing was still infrequent in this group, around 5%. Patients who were tested were four times as likely to start treatment with mineralocorticoid receptor antagonist therapy as those who weren't tested. Patients whose index visits were with a nephrologist or an endocrinologist had higher odds of being tested, compared with those who saw primary care clinicians.

The authors write: "Generally, failure to test patients with apparent treatment- resistant hypertension for primary aldosteronism may reflect a lack of familiarity with this common and treatable condition or a broader propensity for treatment inertia in this patient population."