Hypertension action bundle including training of healthcare professionals to improve the detection of primary aldosteronism: a cohort study

As a blood pressure clinic, we have developed a hypertension action bundle including a training programme to facilitate secondary hypertension screening, delivered during three phases: P1 (2016–2018): for hospital practitioners; P2 (2019–2021): for practitioners working outside of hospitals; P3 (2022–2024): consolidation phase. We hypothesised that a training programme could enhance diagnosis of primary aldosteronism (PA).
This study included patients diagnosed with PA between 2016 and 2024. The primary objective was to investigate the incidence of PA diagnosis across three distinct time periods. In addition, we investigated patient origin, reason for consultation and clinical-biological profile, with a view to gaining insight into the diagnostic process.
A total of 110 PA patients were diagnosed with PA. The annual incidence of primary aldosteronism (PA) per 1000 consultations increased significantly from 1.2 in P1 to 2.64 in P2 (Odds Ratio P1-P2: 2.2 [95CI, 1.2–4.1]) and 4.31 in P3 (Odds Ratio P2-P3: 1.6 [95CI, 1.1–2.4]). This increase can be primarily attributed to enhanced screening by general practitioners and cardiologists. PA screening indications had also evolved over time, shifting from hypokalaemia and hypertension with target organ damage in P2, to pre-eclampsia, refractory hypertension or hypertension in young patients in P3. There was little to no change in patient’s clinic-biological profile between periods.
The hypertension action bundling including training of physicians in the management of high blood pressure has resulted in significant advancements in the diagnosis and management of PA, through the identification of less common hypertension profiles.
Despite being the leading cause of secondary hypertension and requiring targeted treatment to control cardiovascular risk, only 2% of patients with primary hyperald­osteronism are diagnosed.
Our study confirms that a training programme can improve the likelihood of diagnosis (by around fourfold) of primary aldosteronism.
This enhancement is the result of a coordinated effort. The general practitioners familiarised themselves with the indications for screening, which include patients under the age of 40 years, or with a history of hypokalaemia, even if it was induced by diuretics. For specialists, awareness of the frequency of PA, particularly in aggressive forms of hypertension, has been decisive. Both groups of physicians reported an increase over time in systematic questioning of refractory hypertension.
The training of gynaecologists and midwives has enabled the identification of pregnant women with hypertensive disorders during pregnancy, who require referral for screening for secondary hypertension.
The implementation of a specific, multidisciplinary, town-hospital approach, combined with training initiatives, has the potential to improve the detection of the main causes of secondary hypertension: primary hyperaldosteronism. These data support the implementation of such approaches.