Electronic Health Record-Based Screening for Primary Aldosteronism in a Large Academic System
Authors' conclusion
PA remains underdiagnosed and undertreated in high-risk populations. Interventions to improve systematic adherence to guideline-based screening may improve detection, management, and cardiovascular outcomes associated with untreated PA.
Study context
- Population
- Hypertensive patients (2017 to 2019) meeting ≥1 Endocrine Society primary aldosteronism (PA) screening criterion: resistant hypertension, hypokalemia, adrenal mass or obstructive sleep apneaof 40,865 hypertensive
- Participants
- 17,735 patients
- Outcome
- PA screening (ARR collected)
Methodological details5-year longitudinal follow-up, ambulatory clinics of a large academic health system
- 5-year longitudinal follow-up
- Ambulatory clinics of a large academic health system
Main finding
As reported in the abstract
- Screened for PA
- 736 (4.1%)
- Screening rate, resistant hypertension
- 4.7%
- Screening rate, hypokalemia
- 8.5%
- Screening rate, adrenal mass
- 26%
- Screening rate, obstructive sleep apnea
- 1.6%
- Positive screen (ARR ≥20 and aldosterone ≥10 ng/dl), of those screened
- 213 (28.9%)
Observational data: associations, not effects.
Further findings
MACE · trend towards fewer events with adrenalectomy
P = 0.1
Treatment of screen-positive patients
- Adrenalectomy
- 26 (12%)
- Mineralocorticoid receptor antagonists
- 81 (38%)
- Untreated
- 106 (50%)
Antihypertensives, systolic BP, hypokalemia resolution · 5 years
- Surgically or medically treated vs untreated: fewer antihypertensive medications, lower mean systolic BP, greater resolution of hypokalemia
Original publication
Electronic Health Record-Based Screening for Primary Aldosteronism in a Large Academic System. Endocr Pract. Published 21 May 2026. doi:10.
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