Prevalence of hyperaldosteronism in primary care patients with resistant hypertension.
BACKGROUND
Because hyperaldosteronism is the most common curable reason for secondary hypertension, screening is recommended. However, prevalence among general practice patients and feasibility of screening is still unclear. A design to assess prevalence in general practice and barriers against screening was created.


METHODS
This was an open, observational pilot study and focus group. In 2 general practices, all patients with arterial hypertension were included. Those with resistant hypertension (>140/90 mm Hg and taking ≥3 antihypertensive drugs) were eligible for screening. The design and feasibility of the study were discussed in a focus group of experienced general practitioners.


RESULTS
Of 3107 patients visiting the practices, 564 were diagnosed as having arterial hypertension. Seventy-nine fulfilled criteria for resistant hypertension. Aldosterone:renin ratio (ARR) could be measured in 63 of those patients. Withdrawal of ß-blocker was feasible in 34 of the 63 with measurable ARR. ARR was positive in 15, and in 3 of those 15 with positive ARR, it was caused by elevated aldosterone levels. Focus group discussion revealed barriers and concerns regarding organizational, financial, and practical aspects of a systematic screening.


CONCLUSIONS
Screening for hyperaldosteronism in general practice seems possible in selected patients, but not in a systematic way. Barriers against systematic screening were a necessity for β-blocker cessation as well as structural prerequisites for patient identification.
Department of Health Services Research, University Bremen, Germany. schmiemann@uni-bremen.de
Guido
G
Schmiemann
Klaus
K
Gebhardt
Eva
E
Hummers-Pradier
Günther
G
Egidi
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D000450:Aldosterone / Q000097:blood; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004351:Drug Resistance / Q000502:physiology*; D005240:Feasibility Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011320:Primary Health Care; D012083:Renin / Q000097:blood
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D000450:Aldosterone; D012083:Renin