Treatable cause of high blood pressure are often ignored, study finds

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In a new study, researchers highlight a chicken-or-the-egg scenario in blood pressure management:

Testing for a disease that’s linked to difficult-to-control blood pressure isn’t happening, possibly because providers think it’s rare or unwieldy, but if more people were tested, experts say we’d discover it’s not rare at all.

The research was conducted by a team at Michigan Medicine and elsewhere.

In the study, the team reviewed data from military veterans diagnosed with treatment-resistant hypertension at a Veterans Health Administration facility between 2000 and 2017.

They found that fewer than 2% of the people who should’ve been evaluated for primary aldosteronism were tested.

Primary aldosteronism is a hormonal disorder that leads to high blood pressure. It occurs when the adrenal glands produce too much of a hormone called aldosterone.

The chances of receiving a needed evaluation were higher when the patient also saw a specialist such as a nephrologist or an endocrinologist discuss their high blood pressure.

There’s an educational gap there where some physicians may think it’s too complicated to test people for this, or don’t know they should be thinking about testing people, the team says.

The current estimates suggest that around 20% of people with uncontrolled high blood pressure despite taking three blood pressure medications may actually be struggling with this treatable disorder.

Management of primary aldosteronism depends on the type diagnosed and may include medications to block the effect of aldosterone in the adrenal gland, or surgery to remove one of the two adrenal glands.

In addition to encouraging conversations with specialists when dealing with uncontrolled blood pressure, the researchers suggest exploring technology to help solve this problem.

That could include an automatic alert prompted in patients’ electronic health records when they meet conditions to warrant an evaluation for primary aldosteronism.

One author of the study is J. Brian Byrd, M.D., M.S., an assistant professor, and cardiologist.

The study is published in the Annals of Internal Medicine.

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