5 minute lightning oral presentation (and poster) ESA-SRB 2023 in conjunction with ENSA

Screening for primary aldosteronism underutilised in stroke and transient ischaemic attack: a multi-centre cohort study (#218)

Josephine McCarthy 1 2 3 4 , Jocelyn Widjaja 1 , Frank M. Gao 5 6 , Ignatius J.H. Lee 7 , Jordan H.N.C. Lai 8 , Sanjana Gupta 9 , Jason Vuong 1 10 , Philip M.C. Choi 11 12 , Thanh G. Phan 1 10 , Jun Yang 1 2 3
  1. Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
  2. Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
  3. Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
  4. Department of Endocrinology, Eastern Health, Box Hill, Victoria, Australia
  5. Department of Medicine, Austin Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
  6. Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
  7. Goulburn Valley Health, Shepparton, Victoria, Australia
  8. Department of Medicine, Eastern Health, Box Hill, Victoria, Australia
  9. The Royal Melbourne Hospital, Melbourne, Victoria, Australia
  10. Department of Neurology, Monash Health, Clayton, Victoria, Australia
  11. Department of Neuroscience, Eastern Health, Box Hill, Victoria, Australia
  12. Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Victoria, Australia

Primary aldosteronism (PA) is the most common endocrine cause of hypertension. People with hypertension due to PA have a higher rate of adverse cardiovascular events including stroke compared to those with blood pressure matched essential hypertension. (1) Targeted treatment with mineralocorticoid receptor antagonists or surgical resection for an aldosterone producing adenoma can effectively reduce blood pressure and ameliorate the increased cardiovascular risk. (2)

Aim: The aim of this study was to evaluate the proportion of patients admitted for stroke or transient ischaemic attack (TIA) who had an indication for PA testing according to the Endocrine Society 2016 Guideline and the proportion who were actually tested. (3) Method: This retrospective cohort study was conducted at two tertiary health services in Melbourne. Patients were included in analysis if they were admitted for stroke or TIA in 2019 and had documentation of blood pressure and concurrent medications within 2 years of admission. We screened 1,110 patient records and excluded 710 due to missing data. Results: Of the 400 patients analysed, 298 (75%) had a history of hypertension or were hypertensive at the time of discharge and 75 (19%) had indications for PA testing. Only 8 (2%) were considered for PA testing. Seven patients had an aldosterone to renin ratio and one had an adrenal CT. Six of the seven patients with an aldosterone to renin ratio were on interfering medications which can cause false negative results. One patient was lost to follow up and no patients underwent formal testing as recommended by the Endocrine Society. Conclusion: In conclusion, a quarter of patients admitted with stroke or TIA and hypertension have an indication for PA testing. However, few are ever tested appropriately. Appropriate PA screening in this population may identify a potentially curable cause of hypertension, improve blood pressure control and reduce stroke recurrence.

  1. (1) Monticone S, D’Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2018;6:41–50.
  2. (2) Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6:51–59.
  3. (3) Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF Jr. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101:1889–1916.