Outcomes of a Specialized Clinic on Rates of Investigation and Treatment of Primary Aldosteronism

IMPORTANCE Primary aldosteronism (PA) is one of the most common causes of secondary hypertension but remains largely unrecognized and untreated. OBJECTIVE To understand the outcomes of a specialized clinic on rates of evaluation and treatment of PA in the context of secondary factors. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study was conducted in Alberta, Canada, using linked administrative data between April 1, 2012, and July 31, 2019, on adults identified as having hypertension. MAIN OUTCOMES AND MEASURES We evaluated each step of the diagnostic and care pathway for PA to determine the proportion of people with hypertension who received screening, subtyping, and targeted treatment for PA. Variations in diagnosis and treatment were examined according to individual-level, clinician-level, and system-level characteristics. RESULTS Of the 1.1 million adults with hypertension, 7941 people (0.7%) were screened for PA. Among those who were screened, 1703 (21.4%) had positive test results consistent with possible PA, and 1005 (59.0%) of these were further investigated to distinguish between unilateral and bilateral forms of PA. Only 731 individuals (42.9%) with a positive screen result received disease-targeted treatment. Geographic zones and clinician specialty were the strongest determinants of screening, subtyping, and treatment of PA, with the highest rates corresponding to the location of the provincial endocrine hypertension program. CONCLUSIONS AND RELEVANCE In this cohort, less than 1% of patients expected to have PA were ever formally diagnosed and treated. These findings suggest that a system-level approach to assist with investigation and treatment of PA may be highly effective in closing care gaps and improving clinical outcomes. Published online March 31, 2021.

Automated summary

Primary aldosteronism (PA) is a common but often unrecognized cause of secondary hypertension. A specialized clinic can improve the rates of evaluation and treatment for PA, with geographic zones and clinician specialty being key determinants. A system-level approach may be effective in closing care gaps and improving outcomes for patients with PA.