Primary Aldosteronism

Aldosteronism Testing Is Rare, Despite Guidelines

Patients with treatment-resistant hypertension are not routinely tested for primary aldosteronism (plasma alderosterone-renin), according to the results of a recent study. This finding demonstrates a low adherence to guideline recommendations.

The researchers conducted a respective cohort study that examined the rate of testing, as well as mineralocorticoid receptor antagonist (MRA) use in US veterans. The researchers utilized data from the U.S. Veterans Health Administration from 2000 to 2017 including 269,010 veterans.

All participants had apparent treatment-resistant hypertension, defined in this study as either hypertension requiring 4 antihypertensive classes or 2 blood pressures (BPs) at least 1 month apart of at least 140 mm Hg (systolic) or 90 mm Hg (diastolic) while using 3 antihypertensive agents, including the use of a diuretic.

The results indicated that just 1.6% of patients (n=4277) with treatment-resistant hypertension had been tested for primary aldosteronism. In addition, the researchers found that patients who completed their index visit with a nephrologists or endocrinologist instead of a primary care physician were more likely to be tested.

“In a nationally distributed cohort of veterans with apparent treatment-resistant hypertension, testing for primary aldosteronism was rare and was associated with higher rates of evidence-based treatment with MRAs and better longitudinal BP control,” the researchers concluded. “The findings reinforce prior observations of low adherence to guideline-recommended practices in smaller health systems and underscore the urgent need for improved management of patients with treatment-resistant hypertension.”

—Leigh Precopio


Cohen JB, Cohen DL, Herman DS, Leppert JT, Byrd JB, Bhalla V. Testing for primary aldosteronism and mineralocorticoid receptor antagonist use among U.S. veterans. Published online December 29, 2020. Ann Intern Med. doi: 10.7326/M20-4873