Background: Primary aldosteronism (PA) accounts for 3.2-12.7% of hypertension in primary care but is rarely diagnosed. The Endocrine Hypertension Service (EHS) was established in July 2016 to address the low diagnostic rate by offering education and a streamlined diagnostic pathway to primary care clinicians.
Aims: To analyse the impact of Victoria’s first dedicated EHS on PA diagnoses.
Methods: Clinical data from all patients who attended the EHS since July 2016 (N=242) was collected prospectively. Sociodemographic information was obtained from patient questionnaires, while medical information was obtained from hospital records. Patients were divided into Year 1 (Y1), Year 2 (Y2), and Year 3 (Y3), based on the date of their first EHS visit.
Results: Following the establishment of the EHS, the proportion of referrals from primary care increased (20% in Y1, 47% in Y2, 54% in Y3) with more referrals being made for treatment-naive hypertension (2 in Y1, 10 in Y2, 22 in Y3). Amongst PA patients, the median duration of hypertension prior to the first EHS visit decreased (11 years in Y1, 10 years in Y2, 9 years in Y3), and the prevalence of end-organ damage decreased (44% in Y1, 42% in Y2, 23% in Y3). Targeted management of PA improved clinical and biochemical outcomes. The average reduction in blood pressure following targeted management increased from 15/11mmHg in Y1 to 18/13mmHg in Y2 and 30/22mmHg in Y3.
Conclusion: The EHS together with PA-related education programs led to increased primary care referrals and detection of PA earlier in the course of hypertension in patients who otherwise would have had a missed or delayed diagnosis. Referred patients were on fewer antihypertensives and had less end-organ damage which simplified the PA diagnostic process, allowing targeted treatment to be commenced earlier and patient outcomes optimised.