9169 Evaluation Of Screening Practices For Primary Aldosteronism In Patients With Treatment Resistant Hypertension

Abstract Disclosure: N. Markovic: None. M. Brankovic: None. A.P. Smith: None. A. Mittal: None. D. Matassa: None. Background: Despite the recognized high prevalence of primary aldosteronism (PA) in patients with treatment resistant hypertension (TRH), PA remains underdiagnosed. Our aim was to investigate the appliance of screening recommendations for secondary causes of TRH in the largest inner-city population in New Jersey. Method: The retrospective chart review analysis included all patients with TRH evaluated in the internal medicine clinic from July 2020 to July 2021. Initial patient charts were obtained based on the number of antihypertensive medications used for treatment. All patients on 3 or more antihypertensives, including one diuretic, were evaluated. Subsequently of 242 charts evaluated, 102 were excluded due to either patient noncompliance with medications or being controlled on 3 antihypertensive medications including diuretic. All patients who did not have BP at goal (>140/90 mmHg) while on 3 antihypertensives or BP at goal while on 4 antihypertensives were included in the study. Result: Of 140 patient charts included, 66.4 % were female and 33.6% male. Most of our population based on race and ethnicity were African American (66.8%) and Latin American (14.3%), Asian and White represented 2.1% and 1.4%, respectively, and 13.6% declared themselves as other. In patients with TRH microalbumin/creatinine ratio was checked in 95.7%, CMP in all patients, HbA1C in 98.6%, TSH in 93.6%, PTH in 29.3% and uric acid in 28.6%. Plasma renin was ordered by providers in 32 patients (22.9%) and plasma aldosterone in 33 patients (23.6%) out of which plasma aldosterone to plasma renin ratio was completed in 10.7% of patients at least one time, 5.7% two times and 2.9% three or more times. Renal artery ultrasound was completed in 17.1% out of which 0.7% (1 patient) was found to have renal artery stenosis. CT abdomen/pelvis was performed in almost half of our patients (49.3%) and majority (92.9%) had ophthalmology referral. There were no differences in the screening for PA based on patient race, ethnicity, and insurance. Conclusion: This data shows that in patients with TRH only less than one third had appropriate work-up ordered that included plasma aldosterone to plasma renin ratio with an even smaller percentage of patients completing the test. Our next step is to increase the number of charts reviewed and to develop tools that will be available in the clinical settings to increase the frequency of screening for PA in patients with TRH. Presentation: 6/1/2024