Authors (including presenting author) :
Lee ACH (1), Leung SK (1), Chang JYC (1), Woo CSL (1), Leung EKH (1), Lui DTW (1), Lee PCH (1), Lam JKY (1), Woo YC (1), Ip TP (1)(2), Chow WS (1), Lam KSL (1), Tan KCB (1)
Affiliation :
(1) Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
(2) Department of Medicine, Tung Wah Hospital, Hong Kong
Introduction :
Primary aldosteronism (PA) is most common cause of endocrine hypertension, affecting up to 6% (primary care) and 16% (referral centres) of hypertensive patients. The importance of PA is highlighted by the excess cardiovascular/renal morbidities and mortality compared to blood pressure-matched patients with essential hypertension (EH). Effective treatment has been shown to reduce such risks so that they become comparable to or even lower than those observed in EH. However, the low detection rate and delay in diagnosis is prevalent globally.
Objectives :
To determine whether under- or delayed diagnosis of PA is evident from the perspective of a local endocrinology referral centre.
Methodology :
The electronic records of all patients diagnosed with PA in Queen Mary Hospital endocrinology centre from 2009 to 2020 were reviewed, focusing on the prevalence of spontaneous hypokalaemia in our cohort, the duration of hypertension and hypokalaemia prior to diagnosis as well as the time from screening to confirming the diagnosis [years, expressed as median (interquartile range)].
Result & Outcome :
247 patients were diagnosed to have PA during the period 2009-2020. Males (55%, 136/247) were slightly more commonly affected. Spontaneous hypokalaemia, a classical feature of PA, was present in 94% (232/247) of cases in our cohort, however it was only present in up to 9-37% of PA cases in international centres with comprehensive screening programs. A gross under-diagnosis of PA (especially the normokalemic form) is thus likely. The median duration of hypertension and hypokalemia prior to diagnosis of PA was 8.8 years (3.1-13) and 4 years (1.1-7.7), respectively. Aldosterone-renin ratio (ARR) is the recommended screening test of PA and it took 0.4 years only (0.3-0.8) from obtaining an ARR to confirming the diagnosis. Therefore, the marked delay in diagnosis was mainly attributed to delayed screening by ARR. In conclusion, clinicians should know most PA patients are normokalemic and initiate early proactive screening by ARR in hypertensive patients at risk of PA according to international guidelines.
