SAT-481 Enhanced Detection Of Primary Aldosteronism In Hypertensive Patients With Obstructive Sleep Apnea Using A Novel Diagnostic Algorithm

Abstract Disclosure: S.N. Shah: None. K. Wright: None. I. Suh: Corcept Therapeutics. M. Mahmoudi: None. N. Agrawal: Xeris, Amryt, Camarus, Recordati, Ascendis. Background: Primary aldosteronism (PA) is a common but underdiagnosed disorder with significant health impacts that can be mitigated by proper treatment. Some advocate for more lenient screening protocols to improve diagnostic sensitivity and minimize the number of untreated patients. Methods: We previously reported on PA screening rates among a cohort of adult patients with comorbid obstructive sleep apnea (OSA) and hypertension (HTN). PA screening within a subset of this population was performed using serum aldosterone levels, aldosterone:plasma renin activity ratio (ARR), and plasma renin activity (PRA). Screening results using the novel diagnostic algorithm proposed by Vaidya & Carey (serum aldosterone and PRA criteria) were compared to those using the 2016 Endocrine Society Guidelines (serum aldosterone and ARR criteria). Results: Of 457 patients with comorbid OSA and HTN, 97 were screened for PA (21%). These patients were predominantly male with an average age of 58.6 years. The most frequent comorbidities included hyperlipidemia (80%) and diabetes mellitus (31%). Most had moderate or severe OSA (41% and 34%, respectively) and 20% had drug-resistant HTN. Using Endocrine Society guidelines, 7% of patients had positive PA screens and 11% had indeterminate screens due to concurrent use of interfering medications. The remaining 81% of patients had negative screening results. In contrast, using the Vaidya & Carey algorithm, 33% of patient screens were positive. Seven percent of these were overtly positive and did not require additional testing. Thus, 26% of patients that had negative screens using Endocrine Society guidelines were reclassified as positive screens using the new algorithm. In addition, each of eleven patients with indeterminate screens using Endocrine Society guidelines were classified as negative due to absence of renin suppression. Using a stricter definition of suppressed PRA, the Vaidya & Carey algorithm yielded positive screens in 24% of patients and negative screens in 75%. Conclusion: More robust PA screening is crucial given the morbidity associated with untreated PA. The Vaidya & Carey diagnostic algorithm enhances the sensitivity of PA screening by increasing detection of cases and clarifying the diagnosis of cases that were previously deemed indeterminate. Improving screening strategies may reduce long-term healthcare costs by preventing complications of uncontrolled HTN, such as heart failure, myocardial infarction, and stroke, which place a substantial economic burden on the healthcare system. Future prospective studies are warranted to validate these findings in broader populations. Presentation: Saturday, July 12, 2025