Study: Too few with high blood pressure tested for hormone disorder

More people with treatment-resistant high blood pressure should be receiving tests for a hormone disorder that can increase pressure, researchers say. Photo by Bru-nO/Pixabay
More people with treatment-resistant high blood pressure should be receiving tests for a hormone disorder that can increase pressure, researchers say. Photo by Bru-nO/Pixabay

Dec. 28 (UPI) -- Fewer than 2% of people with treatment-resistant high blood pressure are checked for a hormone disorder that can drive blood pressure higher, a study published Monday by the Annals of Internal Medicine found.

In people with primary aldosteronism, the adrenal gland produces too much of a hormone called aldosterone, causing increases in blood pressure, often to unhealthy levels, according to the Mayo Clinic.


Professional guidelines recommend checking those with high blood pressure that doesn't respond to treatment for the hormonal disorder, but researchers found the tests often are not performed.

"While primary aldosteronism is a common cause of difficult to control hypertension, it is under-diagnosed," study co-author Dr. Jordana Cohen told UPI.

"Patients who were tested in our study were more likely to be treated with the appropriate medications ... and to have better blood pressure control over time, said Cohen, an assistant professor of medicine and epidemiology at the University of Pennsylvania.

Many people who don't respond well to commonly used blood pressure control medications, including beta blockers and ACE inhibitors, are found to have the hormone disorder, Cohen and her colleagues said.

The condition has been linked with a four- to 12-fold increased risk for cardiovascular events, such as heart attack and stroke, compared to those with high blood pressure due to other causes, the researchers said.


However, the disorder can be effectively treated with drugs called mineralocorticoid receptor antagonists, or MRAs, including spironolactone and eplerenone, or surgery, according to Cohen.

For this study, she and researchers at the University of Pennsylvania, Stanford University and the University of Michigan reviewed data from the Veterans Health Administration for more than 269,000 veterans with apparent treatment-resistant high blood pressure.

Treatment-resistant hypertension was defined as either two blood pressures of at least 140 systolic or 90 diastolic at least one month apart. Patients also had to be receiving treatment with at least three blood pressure drugs, including a diuretic, or with at least four different types of blood pressure drugs, the researchers said.

Just under 2% of patients with treatment-resistant high blood pressure underwent guideline-recommended testing for the hormone disorder, the data showed.

Testing rates ranged from 0% to 6% at centers included in the study and did not correlate with the number of patients with treatment-resistant hypertension, the researchers said.

And just 15% of the patients were on an MRA drug, the data showed.

Patients tested for the hormone condition were more likely to receive treatment with MRAs and have better long-term blood pressure control, according to the researchers.


Testing rates also did not change meaningfully over nearly two decades of follow-up despite an increasing number of guidelines recommending testing for the disorder in this population, they said.

"If you are on three or more medications for management of your blood pressure, ask your doctor if they think you might benefit from testing or from being treated with an MRA," Cohen said.

"Not all patients are appropriate to be tested or treated with MRAs, but most people with treatment resistant hypertension are," she said.

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