Should All Patients with Resistant Hypertension Be Screened for Primary Aldosteronism?

Carrie C. Lubitz, MD, MPH Assistant Professor of Surgery, Harvard Medical School Senior Scientist, Institute for Technology Assessment Attending Surgeon, Mass General/North Shore Center for Outpatient Care Danvers, Massachusetts

Dr. Lubitz

MedicalResearch.com Interview with:
Carrie C. Lubitz, MD, MPH
Assistant Professor of Surgery, Harvard Medical School
Senior Scientist, Institute for Technology Assessment
Attending Surgeon, Mass General/North Shore Center for Outpatient Care
Danvers, Massachusetts

Medical Research: What is the background for this study? What are the main findings?

Dr. Lubitz: Given reported estimates of resistant hypertension and the proportion of resistant hypertensive patients  with primary hyperaldosteronism (PA) – the most common form of secondary hypertension caused by a nodule or hyperplasia of the adrenal glands – we estimate over a million Americans have undiagnosed PA. Furthermore, it has been shown that patients with PA with the same blood pressure as comparable patients with primary hypertension have worse outcomes.

In our study, we found that identifying and appropriately treating patients with PA can improve long-term outcomes in patients in a large number of patients who have resistant hypertension.

Medical Research: What should clinicians and patients take away from your report?

Dr. Lubitz: For patients and clinicians faced with a patient with difficult to treat hypertension, screening (with a blood test) and for primary hyperaldosteronism, and if positive, assessment for unilateral disease (i.e. surgical candidate) versus MRA (for bilateral adrenal hyperplasia) is warranted.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Lubitz: A prospective, controlled trial comparing the blood pressure change between each of the following groups of patients with

1) primary resistant hypertension treated with the addition of a mineralocorticoid receptor antagonist (MRA) such as spironolactone or eplerenone,

2) PA patients  (caused by bilateral adrenal hyperplasia) treated with MRA’s, and

3) Primary hyperaldosteronism  patients with unilateral disease treated with adrenalectomy.  The next phase of our work will address the issue of whether screening all patient with primary hypertension – not only those with resistant hypertension – is cost-effective.

Citation:

Lubitz CC, Economopoulos KP, Sy S, Johanson C, Kunzel HE, Reincke M, Gazelle GS, Weinstein MC, Gaziano TA.

Circ Cardiovasc Qual Outcomes. 2015 Nov 10. pii: CIRCOUTCOMES.115.002002. [Epub ahead of print] PMID 26555126

Carrie C. Lubitz, MD, MPH (2015). Which Resistant Hypertension Patients Should Be Screened for PA? 

 

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