Improving primary aldosteronism diagnosis and treatment: outcomes from an endocrine hypertension service

AIMS: To evaluate the sustained impact of the Endocrine Hypertension Service on primary aldosteronism (PA) diagnosis and management over a subsequent 3-year period. BACKGROUND: PA is a prevalent yet underdiagnosed cause of secondary hypertension, associated with increased cardiovascular, renal and metabolic risk. Limited awareness, resources and expertise contribute to delays in diagnosis and treatment. A dedicated Endocrine Hypertension Service previously improved PA screening and increased primary care referrals in its first 3 years (2016-2019). METHODS: We conducted a retrospective analysis of consecutive new patients seen at a tertiary Endocrine Hypertension Service in Victoria, Australia, from 1 July 2019 to 30 June 2022, including significant COVID-19 disruptions. Clinical data were analysed by referral year (Y1: 2019/2020, Y2: 2020/2021, Y3: 2021/2022) to assess changes over time. RESULTS: A total of 457 new patients were assessed, with referrals increasing over time (Y1: 115; Y2: 156; Y3: 186). Most referrals originated from primary care (50%), followed by cardiology (23%). At presentation, 20% of patients were treatment-naïve, median hypertension duration was 4 years, and 22% had end-organ damage. Of the cohort, 213 had PA, 171 did not, and 73 were 'undetermined' due to incomplete work-up. Among 171 patients with PA treated medically, 78% achieved complete biochemical response and 46% complete clinical response on MRA monotherapy, as defined by the Primary Aldosteronism Medical Outcome (PAMO) criteria. Among 34 patients who underwent unilateral adrenalectomy, 86% achieved complete biochemical response and 39% complete clinical response, according to the Primary Aldosteronism Surgical Outcome (PASO) criteria. CONCLUSION: Growth in referrals, earlier detection and high treatment response rates highlight the sustained effectiveness of a structured pathway for timely PA diagnosis and management, despite COVID-19 disruptions.