Abstract: FR-PO735
Screening for Primary Hyperaldosteronism in Patients With Resistant Hypertension in an Outpatient Clinic
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials
Authors
- Anandasivam, Nidharshan S., The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Vasudevan, Jaya, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Benson, Douglas, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Medhus, Annika L., The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Sarkaria, Paul, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Gagrani, Sonal, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Herrera-Doerre, Brandon, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Karimi, Ava, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Ben-Nun, David J., The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Soneji, Nisha, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Aggarwal, Arjun, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Taylor, Steven, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Sadler, Holli, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Lubetzky, Michelle L., The University of Texas at Austin Dell Medical School, Austin, Texas, United States
- Moriates, Christopher, The University of Texas at Austin Dell Medical School, Austin, Texas, United States
Background
Clinical practice guidelines recommend screening for primary hyperaldosteronism (PH) in patients with resistant hypertension (HTN). However, screening rates are low in the outpatient setting. We aimed to increase screening rates for PH in patients with resistant HTN in our VA outpatient clinic from 24% to 80%.
Methods
Patients with resistant HTN were identified through a VA Primary Care Almanac Metric query with subsequent medical record review for resistant HTN criteria. Medication adherence was reviewed to rule out pseudo-resistant HTN. Three sequential patient-directed interventions were implemented. In the first intervention, patients with resistant HTN had preclinic screening (plasma aldosterone concentration and plasma renin activity) labs added on and were scheduled in clinic for hypertension follow-up. In the second intervention, patients without screening labs were called to confirm adherence to medications and counseled on the need for labs to screen for PH. In the final intervention, patients with positive screening labs (plasma aldosterone concentration>5-15ng/dL and plasma renin activity<1ng/ml/hr) were called to discuss mineralocorticoid receptor antagonist (MRA) initiation and Endocrinology referral.
Results
Of 97 patients with resistant HTN, 58 were found to have true resistant HTN, while 39 had pseudo-resistant HTN from medication non-adherence. Of the 58 with resistant HTN, 44 were not previously screened for PH, while 14 (24%) had already been screened or were already taking an MRA. Our screening rate for PH in resistant HTN patients increased from 24% at the start of the study to 84% (37/44 unscreened patients were ultimately screened). A total of 9 patients were found to have a positive screen for PH, and 5 were started on MRAs. None of these 5 patients developed hyperkalemia.
Conclusion
This quality improvement project demonstrated that a focused intervention process improved PH screening rates. Over 20% of screened patients had labs positive for PH.