MON-287 Addressing Diagnostic Inequities In Primary Aldosteronism: Health Disparities, Precision Care Innovations, And Cardiovascular Risk Reduction In Resistant Hypertension

Abstract Disclosure: P.D. Rupasinghe: None. S.N. Durrani: None. N.G. Abdelrahman: None. Context: Primary aldosteronism (PA), the most common endocrine cause of secondary hypertension, affects 5-10% of hypertensive individuals and up to40% of hypertension. Despite its 4-12× higher cardiovascular risk, PA remains under diagnosed due to normokalemia (38% of cases), inconsistent aldosterone-renin ratio (ARR), and systemic disparities in confirmatory testing. Black patients face compounded barriers, including reduced confirmatory testing despite higher screening rates. CETO PET imaging offers precision care potential, though equitable implementation lags. Objective: This review assesses PA detection rates, identifies diagnostic gaps and inequities, and evaluates therapeutic innovations using large-scale data. Focus is in screening access, biologic/systemic diagnostic barriers, and emerging precision technologies. Method: A PRISMA-guided systematic review analyzed cohorts, meta-analyses, and trials (2010-2023) from ENSAT (n=3,812), AVIS-2 (n=1,506),NHANES 2017-2Biobank (n=502,490), and SPRINT (n=9,361). Inclusion criteria prioritized studies reporting PA prevalence, screening, diagnostic accuracy, or treatment outcomes odds ratios (ORs), and Area Under the (ROC) Curve (AUCs)were calculated; disparities were analyzed via multivariable regression. Study quality was assessed using the Newcastle-Ottawa scale. Results: PA prevalence was 16.1% in resistant hypertension (n=12,743)and 28.5% in hypokalemic hypertensives (n=3,890). NHANES data showed only 1.2%of hyper testing, with <0.3% undergoing confirmatory testing. Black patients had higher screening odds (OR 1.52, 95% CI 1.2-1.9) but 30% lower confirmatory test patients. ARR performance varied by race (AUC 0.68 in Black vs. 0.81 in White cohorts), reflecting biological and access disparities. 18F-CETO PET demonstrated with adrenal vein sampling (AVS), reducing reliance on invasive AVS. Adrenalectomy achieved biochemical cure in 94% of lateralized PA cases, while mineralocorticoid receptor antagonists (MRAs) decreased cardiovascular events by 34% (HR 0.66, 95% CI 0.54-0.79) in bilateral PA. Expanding screening under the American College of Cardiology (ACC) /American Heart Association (AHA)targets (<130/80 m∼8% of annual hypertension-related strokes. Conclusion: PA is a major, modifiable cardiovascular risk factor in resistant hypertension. Underdiagnosis persists due to systemic inequities, biological variability in fragmented care. Equitable adoption of advanced diagnostics (e.g., 18F-CETO PET), race-adjusted ARR cutoffs, and policy-driven screening expansion are critical. care and dismantling access barriers could prevent thousands of cardiovascular events annually. Presentation: Monday, July 14, 2025