Year: 2024
Type: article
Study design: Observational Study
Abstract: L.M. Mermejo: None. L. Bashaw: None. T. Ellies: None. A.F. Turcu: None. Background: Primary aldosteronism (PA) is a common cause of hypertension and an independent risk factor for cardiovascular morbidity and mortality. Yet, <3% of patients meeting international screening recommendations are ever evaluated for PA. The overwhelming rates of hypertension in the US and globally, and the competing demands on primary care clinicians might dilute the recognition of PA screening candidates. Predictors of positive PA screening could enhance the yield of testing and refine future practice guidelines. Methods: We included adults with hypertension who were identified as candidates for PA screening via a best-practice advisory, and who had concomitant aldosterone and renin measurements between 10/1/2021 and 12/31/2023. Results were classified as: 1) positive screening for PA if plasma aldosterone concentration (PAC):direct renin concentration (DRC) ratio was >2.6 (ng/dL)/(pg/mL), or DRC<8 pg/mL and PAC>10 ng/dL; 2) low renin hypertension (LRH) if DRC<8 pg/mL and criteria for PA not met; and 3) high renin hypertension (HRH) for all others. We extracted demographics and relevant comorbidities. We used stepwise logistic regression to identify predictors of positive PA screening vs. other hypertension types. Results: During the study period, 2197 adults (54% women) with hypertension completed PA screening. Mean age was 60.5 ± 17.1 years; 72.2% patients were White, 21.4% Black, and 3.4% Asian. Of these, 483 (22.2%) patients had positive PA screening, 201 (9.3%) had LRH, and 1487 (68.5%) had HRH. On average, the PA group was older (64.0 years) compared to both the LRH (58.6 years) and HRH (59.6 years). Patients with HRH had the highest proportion of men (48.1%, vs. 41.7% and 40.3% in PA and LRH, respectively), and the highest proportion of White individuals (77.1% vs. 61.9% in PA, and 60.7% in LRH). Independent predictors of positive PA screening included: Black (OR 2.14, [95%CI 1.67-2.74], p<0.0001) and Asian (2.21 [1.29-3.81], p=0.004) vs. White race; older age (1.01 [1.00-1.02], p=0.02); hypokalemia (4.36 [2.62-7.23]), resistant hypertension (4.25 [2.53-7.12]), and an adrenal nodule (3.74 [2.00-6.97]), p<0.001 for all). Conversely, chronic kidney disease (2.31 [1.54-3.46], p<0.0001), obesity (1.69 [1.24-2.30], p=0.0009), diabetes mellitus (1.45 [1.18-1.78]), dyslipidemia (1.27 [1.01-1.61]), and non-Black race, were independent predictors of HRH (vs. all other). while stroke was a predictor of LRH (1.89 [1.10-3.24] vs. HRH, p=0.02). Although the PA group had the highest proportion of composite cardiac morbidity, individual disorders (atrial fibrillation, myocardial infarction, or coronary artery disease) did not have discriminatory value when adjusted for covariates. Conclusion: Projection scores incorporating demographic and clinical data might assist in streamlining and prioritizing PA screening. Saturday, June 1, 2024
Source: Journal of the Endocrine Society
Institution: University of Michigan
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,418
OpenAlex ID: W4409918054