FRI149 Internal Medicine Residents Knowledge On Testing For Treatment Resistant Hypertension With The Focus On Primary Aldosteronism - Interim Analysis
Authors: Markovic Nikolina , Brankovic Milos , Palani Arthi , Matassa Daniel 
Published: October 2023

Abstract
Disclosure: N. Markovic: None. M. Brankovic: None. A. Palani: None. D. Matassa: None.
Studies have shown that primary aldosteronism (PA) is an underlying cause in up to 23% of patients diagnosed with treatment-resistant hypertension (TRH).1 However, recent data have suggested that less than 2% of TRH patients would undergo testing for PA despite strong guideline recommendations.2 Given that PA is an easily diagnosed and treatable cause of TRH, our goal was to identify modifiable factors that can increase diagnosis of secondary causes of TRH. Therefore, we aimed to investigate the residents’ knowledge on diagnosis and evaluation of TRH with the focus on PA. This anonymous survey included Internal Medicine residents during their Ambulatory Clinic Rotation. The response rate was 66% with equal distribution across PGY 1-3. Total of 75% of residents defined TRH correctly, but only 66% of all residents would pursue additional testing to identify the secondary causes of TRH in patients who meet criteria for TRH. On average, only 45% of all residents reported having at least one patient with TRH in the past six months. Upon stratification, this percentage increased among PGY-3 residents (61%). Most residents (96%) knew that the renin-to-aldosterone ratio is an appropriate screening method for PA. Appropriately when listed possible options for evaluation of secondary causes of TRH 93% of residents would order plasma renin activity, and 87% would order plasma aldosterone concentration. Among other tests that residents would perform are: TSH (87%), renal ultrasound with arterial Doppler (75%), CBC (34%), and almost one third of residents (27%) would order transthoracic echocardiogram. Furthermore, 43% of residents would discontinue both ACE/ARB and spironolactone, whereas 25% would discontinue only spironolactone for 6 weeks before testing. Sixty percent of residents were interested in learning more about TRH.The most striking finding of this study is that despite most of the residents appropriately identified tests for secondary causes of TRH, only two thirds of residents would investigate secondary causes of TRH in their practice. This may be the contributing factor for underdiagnosis of PA. Additional guidance on therapy that does not interfere with screening tests for PA is needed. In phase 2 of this study, we plan to provide more education in this area to improve the blood pressure control and decrease the risk of cardiovascular morbidity and mortality in TRH patients. References:1. Huang WC, Lin YH, Wu VC et al. Who should be screened for primary aldosteronism? A comprehensive review of current evidence. J Clin Hypertens (Greenwich). 2022;24(9):1194-1203.2. Cohen JB, Cohen DL, Herman DS et al. Testing for Primary Aldosteronism and Mineralocorticoid Receptor Antagonist Use Among U.S. Veterans: A Retrospective Cohort Study. Ann Intern Med. 2021;174(3):289-297.
Presentation: Friday, June 16, 2023