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Abstract: TH-OR21

Hyperaldosteronism Screening Among a Large Diverse Resistant Hypertension Population Within an Integrated Healthcare System

Session Information

Category: Hypertension and CVD

  • 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Kim, Victor David, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States
  • Shi, Jiaxiao, KPSC Research and Evaluation, Pasadena, California, United States
  • An, Jaejin, KPSC Research and Evaluation, Pasadena, California, United States
  • Sim, John J., Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States

Group or Team Name

  • Kaiser Permanente Los Angeles Nephrology
Background

Hyperaldosteronism (HA) is one of the most common causes of resistant hypertension (RH), and screening for HA is recommended. HA is potentially treatable with more targeted therapy and interventions such as mineralocorticoid receptor antagonists (MRAs). We sought to determine the rate of screening for HA and use of MRAs among a large diverse RH population from an integrated health system.

Methods

A cross-sectional study was performed within Kaiser Permanente Southern California using electronic health records. We identified patients with RH between 7/1/2014 and 6/30/2015 using a criteria of systolic blood pressure >130 mm Hg on 3 or more antihypertensive medicines or requiring 4 or more medicines regardless of BP. We evaluated the rate of serological screening for HA among those with RH. Screening captured as closest date before or after 5 years of RH index date. Positive screen for HA was defined as aldosterone renin ratio>/=20 or aldosterone level >/= 15 ng/dl. We evaluated patient demographic and clinical characteristics, and MRA use among RH and HA patients.

Results

Among 102,480 RH patients (Hispanic = 24.5%, black = 19.5%, white = 44.4%, Asian = 8.6%), a total of 2,824 (2.8%) patients were screened for HA and among them, 1,170 (41.4%) patients met criteria for HA. HA patients were more likely to be male, black, and had lower potassium levels (3.9 vs 4.1 mEq/L). MRA use was 6.5% among all RH, 14.7% among all screened, and 31.7% among patients with HA.

Conclusion

Among a large diverse RH population, we observed a low rate of screening for HA while the positivity rate was high among those screened. MRA use was low in the RH population but higher among HA patients. Understanding potential barriers to HA screening and empiric use of MRA among the RH population warrant further investigation.