Resistant hypertension is associated with higher rates of cardiovascular disease, kidney disease, and death than primary hypertension. Although clinical practice guidelines recommend screening for primary aldosteronism among persons with resistant hypertension, rates of screening are unknown. We identified 145 670 persons with hypertension and excluded persons with congestive heart failure or advanced chronic kidney disease. Among this cohort, we studied 4660 persons ages 18 to <90 from the years 2008 to 2014 with resistant hypertension and available laboratory tests within the following 24 months. The screening rate for primary aldosteronism in persons with resistant hypertension was 2.1%. Screened persons were younger (55.9±13.3 versus 65.5±11.6 years; P<0.0001) and had higher systolic (145.1±24.3 versus 139.6±20.5 mm Hg; P=0.04) and diastolic blood pressure (81.8±13.6 versus 74.4±13.8 mm Hg; P<0.0001), lower rates of coronary artery disease (5.2% versus 14.2%; P=0.01), and lower serum potassium concentrations (3.9±0.6 versus 4.1±0.5 mmol/L; P=0.04) than unscreened persons. Screened persons had significantly higher rates of prescription for calcium channel blockers, mixed α/β-adrenergic receptor antagonists, sympatholytics, and vasodilators, and lower rates of prescription for loop, thiazide, and thiazide-type diuretics. The prescription of mineralocorticoid receptor antagonists or other potassium-sparing diuretics was not significantly different between groups (P=0.20). In conclusion, only 2.1% of eligible persons received a screening test within 2 years of meeting criteria for resistant hypertension. Low rates of screening were not due to the prescription of antihypertensive medications that may potentially interfere with interpretation of the screening test. Efforts to highlight guideline-recommended screening and targeted therapy are warranted.

中文翻译：

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顽固性高血压原发性醛固酮增多症的筛查率

与原发性高血压相比，顽固性高血压与更高的心血管疾病、肾脏疾病和死亡率相关。尽管临床实践指南建议对顽固性高血压患者进行原发性醛固酮增多症筛查，但筛查率尚不清楚。我们确定了 145 670 名高血压患者，并排除了充血性心力衰竭或晚期慢性肾病患者。在该队列中，我们研究了 2008 年至 2014 年间 4660 名年龄在 18 岁至 90 岁以下的顽固性高血压患者，并在接下来的 24 个月内进行了可用的实验室检查。顽固性高血压患者原发性醛固酮增多症筛查率为2.1%。接受筛查的人更年轻（55.9±13.3 岁与 65.5±11.6 岁；P<0.0001）并且收缩压较高（145.1±24.3 与 139.6±20.5 毫米汞柱；P=0。04) 和舒张压（81.8±13.6 vs 74.4±13.8 mm Hg；P<0.0001）、较低的冠状动脉疾病发生率（5.2% vs 14.2%；P=0.01）和较低的血清钾浓度（3.9±0.6 vs 4.1±0.5 mmol/L；P=0.04) 比未经筛查的人。被筛查者的钙通道阻滞剂、混合α/β-肾上腺素能受体拮抗剂、交感神经药和血管扩张剂的处方率明显较高，而袢、噻嗪类和噻嗪类利尿剂的处方率较低。组间盐皮质激素受体拮抗剂或其他保钾利尿剂的处方无显着差异（P=0.20）。总之，只有 2.1% 的符合条件的人在满足顽固性高血压标准的 2 年内接受了筛查测试。筛查率低并不是因为抗高血压药物的处方可能会干扰筛查试验的解释。有必要努力强调指南推荐的筛查和靶向治疗。