PT  - JOURNAL ARTICLE
AU  - Guido Schmiemann
AU  - Klaus Gebhardt
AU  - Eva Hummers-Pradier
AU  - Günther Egidi
TI  - Prevalence of Hyperaldosteronism in Primary Care Patients with Resistant Hypertension
AID  - 10.3122/jabfm.2012.01.110099
DP  - 2012 Jan 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 98--103
VI  - 25
IP  - 1
4099  - http://www.jabfm.org/content/25/1/98.short
4100  - http://www.jabfm.org/content/25/1/98.full
SO  - J Am Board Fam Med2012 Jan 01; 25
AB  - Introduction: Because hyperaldosteronism is the most common curable reason for secondary hypertension, screening is recommended. However, prevalence among general practice patients and feasibility of screening is still unclear. A design to assess prevalence in general practice and barriers against screening was created. Methods: This was an open, observational pilot study and focus group. In 2 general practices, all patients with arterial hypertension were included. Those with resistant hypertension (>140/90 mm Hg and taking ≥3 antihypertensive drugs) were eligible for screening. The design and feasibility of the study were discussed in a focus group of experienced general practitioners. Results: Of 3107 patients visiting the practices, 564 were diagnosed as having arterial hypertension. Seventy-nine fulfilled criteria for resistant hypertension. Aldosterone:renin ratio (ARR) could be measured in 63 of those patients. Withdrawal of ß-blocker was feasible in 34 of the 63 with measurable ARR. ARR was positive in 15, and in 3 of those 15 with positive ARR, it was caused by elevated aldosterone levels. Focus group discussion revealed barriers and concerns regarding organizational, financial, and practical aspects of a systematic screening. Conclusions: Screening for hyperaldosteronism in general practice seems possible in selected patients, but not in a systematic way. Barriers against systematic screening were a necessity for β-blocker cessation as well as structural prerequisites for patient identification.