MON-293 Primary Aldosteronism Among Women with a History of Hypertensive Disorders of Pregnancy

Abstract Disclosure: S. Parisien-La Salle: None. A. Ferrebus: None. E.E. Abel: None. L.C. Tsai: None. A.J. Newman: None. A. Vaidya: None. J.M. Brown: None. Background: Hypertensive disorders of pregnancy (HDP) affect 5-10% of pregnancies and contribute to maternal and fetal morbidity and mortality. Primary aldosteronism (PA) is a frequent, underdiagnosed form of secondary hypertension, present in more than 10-25% of hypertensive patients. Our objective was to evaluate the prevalence and features of PA among women with prior HDP. Methods: Hypertensive adults meeting guideline criteria were prospectively screened for PA using plasma aldosterone and renin through a nationwide, direct-to-patient testing program, wherein positive and negative results were relayed to patients and their primary care clinicians. Women who reported a HDP were subsequently asked to complete a questionnaire to examine the relationship of a positive PA test to HDP and hypertension trajectory. Results: 330 hypertensive women (mean age 62.4 ± 9.8y; 31.2% non-white) with PA testing endorsed a pregnancy history, of whom 83 (25.2%) reported a history of HDP. Those with HDP were younger at hypertension diagnosis (38.8 vs. 47.9y; p <0.001). Interestingly, the prevalence of a positive PA test was high and similar between women with and without a history of HDP (26.5% vs. 32%; p=0.42).Among women with HDP, N=63 completed the follow-up questionnaire, of whom 15 (23.8%) tested positive for PA.Women with PA had a higher prevalence of diabetes (40.0 vs. 18.8%; p=0.16) and CKD (33.3 vs. 8.3%; p=0.029) at the time of PA testing. Age at first hypertensive pregnancy was similar (26.5 vs. 27.6y; p=0.66) but women with PA had a higher prevalence of sustained hypertension (46.7 vs 12.5%; p=0.013), defined as hypertension that did not resolve postpartum, compared to women without PA. Additionally, those with PA experienced a greater proportion of total pregnancies complicated by hypertension (27/36 [75.0%] vs. 71/111 [64.0%]; p=0.022). In those with >1 pregnancy, women with PA more often experienced subsequent hypertensive pregnancies, due to recurrent or sustained hypertension (9/14 [64.3%] vs. 16/41 [39.0%]; p=0.18) compared to women where PA was unlikely. The rate of reported preeclampsia/eclampsia was similar, though patient-reported fetal complications, including fetal losses after 12 weeks, prematurity, and small-for-gestational age, were more common among participants with likely vs unlikely PA (20/36 [55.6%] vs. 31/111 [27.9%] pregnancies; p=0.005). Conclusion: A positive test for PA was highly prevalent in hypertensive women and similar between those with and without a history of HDP. Amidst new guideline recommendations that all adults with hypertension be tested for PA, women with HDP represent a crucial high-risk group that should be prioritized for intensified PA testing to determine candidacy for aldosterone-targeted interventions to mitigate cardiovascular risk. Presentation: Monday, July 14, 2025