Abstract: SA-PO0456
Implementing a Population-Based Testing and Follow-Up Program for Primary Aldosteronism (PA) in Resistant Hypertension (RH): A Pilot Electronic Health Record (EHR)-Driven Approach
Session Information
- CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Sim, John J., Kaiser Permanente Southern California, Pasadena, California, United States
- Kurella Tamura, Manjula, Stanford University, Stanford, California, United States
- Mittman, Brian S., Kaiser Permanente Southern California, Pasadena, California, United States
- Charu, Vivek, Stanford University, Stanford, California, United States
- Harrison, Teresa N., Kaiser Permanente Southern California, Pasadena, California, United States
- Zhou, Matt Mengnan, Kaiser Permanente Southern California, Pasadena, California, United States
- Bhalla, Vivek, Stanford University, Stanford, California, United States
- An, Jaejin, Kaiser Permanente Southern California, Pasadena, California, United States
Background
PA is a treatable cause of hypertension (HTN) with higher prevalence among RH pts. This pilot study evaluated a population health approach to identify and test pts at risk for PA using EHR based criteria and tracked management patterns after testing.
Methods
Within the KPSC HTN registry, we identified pts with RH (≥4 HTN meds) or HTN and hypokalemia (K<3.5 or K supplement use). Exclusion criteria included known secondary HTN, prior PA testing, and kidney failure. Among 200 random pts who met inclusion criteria 1) 100 received outreach (email then phone call) to complete laboratory testing and 2) 100 served as a comparison group.
Results
Among 50382 RH pts, 7930 met criteria with 200 pts included in the pilot cohort. 88 of 100 contacted pts completed testing in 4 months and had aldosterone-renin ratio (ARR) results (59 w email / 32 w phone). Median (IQR) time to complete testing was 14 (5, 33) days. Among outreach tested pts, 23 (26%) had ARR ≥20, while 65 (74%) had ARR <20. Baseline characteristics, blood pressure, and lab values were similar btwn ARR ≥20 vs <20 groups. In the comparison group, 1 pt had PA testing. At baseline, 21% in both groups were on a mineralocorticoid receptor antagonist (MRA). Among no MRA at baseline (n=79 per group), MRA initiation during 15-month follow-up occurred in 7 pts (9%) and 2 (3%) pts were referred for specialist evaluation in the intervention group versus 10 patients (13%) who initiated MRA in the comparison group.
Conclusion
A population-based care management approach to identifying and testing for PA is feasible among higher risk pts with HTN. Targeted outreach increased completion of PA testing and identified substantial proportion of pts with biochemical findings of PA. However, follow through to MRA initiation and/or further workup remained limited.