Screening Rates for Primary Aldosteronism Among Individuals With Hypertension Plus Hypokalemia: A Population-Based Retrospective Cohort Study.
Screening Rates for Primary Aldosteronism Among Individuals With Hypertension Plus Hypokalemia: A Population-Based Retrospective Cohort Study.
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DOI：
10.1161/hypertensionaha.121.18118
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Sood MM
中科院分区：
文献类型：
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作者：
Hundemer GL;Imsirovic H;Vaidya A;Yozamp N;Goupil R;Madore F;Agharazii M;Knoll G;Sood MM
原发性醛固酮增多症是高血压的一种常见但诊断不足的原因，可导致心血管疾病的发病率过高。高血压加低钾血症是指南推荐的筛查原发性醛固酮增多症的指征，但该建议在人群水平上的接受程度仍不清楚。我们对 2009 年至 2015 年加拿大安大略省 18 岁以上患有高血压伴低钾血症（钾 <3.5 mEq/L）的成年人进行了一项基于人群的回顾性队列研究，并随访至 2017 年。我们根据低钾血症频率和严重程度以及同时使用的抗高血压药物，通过醛固酮与肾素比率测量了接受原发性醛固酮增多症筛查的个体比例。我们通过 Cox 回归评估了与筛查相关的临床预测因子。该队列包括 26,533 名成年人，其中只有 422 名 (1.6%) 接受了初级醛固酮增多症筛查。当根据 2 年时间窗口内的低钾血症病例数进行评估时，符合筛查条件的患者比例仅小幅增加，从 1 例低钾血症病例的 1.0% (158/15,983) 增加到≥5 例低钾血症病例的 4.8% (71/1,494)。在患有严重低钾血症（钾<3.0 mEq/L）的个体中，仅 3.9% (58/1,422) 接受了筛查。在服用 ≥ 4 种抗高血压药物的老年人中，仅 1.0% 接受了筛查。内分泌科（HR 1.52 [95%CI 1.10–2.09]）、肾脏科（HR 1.43 [95%CI 1.07–1.91]）和心脏病科（HR 1.39 [95%CI 1.14–1.70]）等亚专科护理与年龄（HR 0.95 [95%CI 1.14–1.70]）筛查可能性增加相关0.94–0.96]）和糖尿病（HR 0.66 [95%CI 0.50–0.89]）与筛查呈负相关。总之，人群对醛固酮增多症初级筛查指南建议的接受度极低。加强教育和意识对于弥合这一差距至关重要。人群对醛固酮增多症初次筛查指南建议的接受度极低。加强教育和意识对于弥合这一差距至关重要。
Primary aldosteronism is a common, yet highly under-diagnosed, cause of hypertension that leads to disproportionately high rates of cardiovascular disease. Hypertension plus hypokalemia is a guideline-recommended indication to screen for primary aldosteronism, yet the uptake of this recommendation at the population level remains unknown. We performed a population-based retrospective cohort study of adults ≥18 years-old in Ontario, Canada with hypertension plus hypokalemia (potassium <3.5 mEq/L) from 2009–2015 with follow-up through 2017. We measured the proportion of individuals who underwent primary aldosteronism screening via the aldosterone-to-renin ratio based upon hypokalemia frequency and severity along with concurrent antihypertensive medication use. We assessed clinical predictors associated with screening via Cox regression. The cohort included 26,533 adults of which only 422 (1.6%) underwent primary aldosteronism screening. When assessed by number of instances of hypokalemia over a 2-year time window, the proportion of eligible patients who were screened increased only modestly from 1.0% (158/15,983) with one instance to 4.8% (71/1,494) with ≥5 instances. Among individuals with severe hypokalemia (potassium <3.0 mEq/L), only 3.9% (58/1,422) were screened. Among older adults prescribed ≥4 antihypertensive medications, only 1.0% was screened. Subspecialty care with endocrinology (HR 1.52 [95%CI 1.10–2.09]), nephrology (HR 1.43 [95%CI 1.07–1.91]), and cardiology (HR 1.39 [95%CI 1.14–1.70]) were associated with an increased likelihood of screening while age (HR 0.95 [95%CI 0.94–0.96]) and diabetes (HR 0.66 [95%CI 0.50–0.89]) were inversely associated with screening. In conclusion, population-level uptake of guideline recommendations for primary aldosteronism screening is exceedingly low. Increased education and awareness are critical to bridge this gap. Population-level uptake of guideline recommendations for primary aldosteronism screening is exceedingly low. Increased education and awareness are critical to bridge this gap.