Prevalence of hyperaldosteronism in primary care patients with resistant hypertension

Introduction: 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 β-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.