Primary aldosteronism (PA) accounts for 3.2-12.7% of hypertension in primary care but is often diagnosed late, if at all. A delayed or missed diagnosis leads to poor blood pressure control and greater cardiovascular risk. The aim of the study was to analyze the impact of Victoria’s first dedicated Endocrine Hypertension Service on the pattern of PA diagnosis. Socio-demographic and clinical data from all patients who attended the Endocrine Hypertension Service since July 2016 (N=267) was collected prospectively. Patients were divided into Year 1 (Y1), Year 2 (Y2), and Year 3 (Y3), based on their first visit. The proportion of primary care referrals increased (20% in Y1, 47% in Y2, 52% in Y3) with more referrals being made for treatment-naive hypertension (3% in Y1, 14% in Y2, 19% in Y3). Amongst PA patients, the median duration of hypertension prior to their first visit decreased (11 years in Y1, 10 years in Y2, 7 years in Y3), and the prevalence of end-organ damage decreased (44% in Y1, 42% in Y2, 33% in Y3). Targeted management of PA improved clinical and biochemical outcomes. The average blood pressure reduction following targeted management increased from 16/12mmHg in Y1 to 23/12mmHg in Y3. The Endocrine Hypertension Service, with its strong component of general practitioner engagement, led to increased primary care referrals and PA detection earlier in the course of hypertension. Referred patients were on fewer antihypertensives and had less end-organ damage which simplified the diagnostic process, allowing targeted treatment to be commenced earlier and patient outcomes optimized.
Authors: Yin Yu Lim, Renata Libianto, Jimmy Shen, Morag J Young, Peter J Fuller, Jun Yang
Keywords: primary care, general practitioner, referral
DOI Number: 10.1111/imj.14879 Publication Year: 2020
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