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Ananda RA, Gwini SM, Long KM, Lai JH, Chen G, Russell GM, Stowasser M, Fuller PJ, Yang J. Diagnostic Delay and Disease Burden in Primary Aldosteronism: An International Patient Survey. Hypertension 2024; 81:348-360. [PMID: 38095087 DOI: 10.1161/hypertensionaha.123.21965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/14/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Primary aldosteronism (PA) is a common but underdiagnosed cause of hypertension. Many patients experience preventable end-organ injury due to delayed or missed diagnosis but data on the experience of patients are limited. METHODS We evaluated the lived experience of PA and determines factors associated with diagnostic delay through an international anonymous online cross-sectional survey, codesigned by researchers and PA consumers. We distributed the survey through academic medical centers, Amazon Mechanical Turk, Twitter, PA patient advocacy groups, and hypertension support groups on Facebook between March 21 and June 5, 2022. RESULTS Of 684 eligible respondents, 66.5% were women. Diagnostic delay (defined as ≥5 years between the diagnosis of hypertension and PA) was reported in 35.6%. Delay was more likely in women than in men (odds ratio, 1.55 [95% CI, 1.10-2.20]) and respondents with ≥3 comorbidities versus none (odds ratio, 1.77 [95% CI, 1.05-3.02]), ≥10 symptoms versus none (odds ratio, 2.73 [95% CI, 1.74-4.44]), and on ≥4 antihypertensive medications versus none (odds ratio, 18.23 [95% CI, 6.24-77.72]). Three-quarters of patients (74.4%) experienced reduced symptom burden following targeted PA treatment. Quality of life improved in 62.3% of patients, and greater improvement was associated with being a woman (odds ratio, 1.42, [95% CI, 1.02-1.97]), receiving adrenalectomy (odds ratio, 2.36 [95% CI, 1.67-3.35]), and taking fewer antihypertensive medications following diagnosis (odds ratio, 5.28 [95% CI, 3.55-7.90]). CONCLUSIONS One-third of patients with PA experienced prolonged diagnostic delays. Targeted treatment led to reduced symptom burden and improved quality of life. Gender differences in diagnostic delay and symptom burden are prominent. These findings suggest that routine screening for PA at the onset of hypertension may reduce diagnostic delay and facilitate timely diagnosis.
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Affiliation(s)
- Roshan A Ananda
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia (R.A.A., J.H.L., P.J.F., J.Y.)
- School of Public Health, Imperial College London, United Kingdom (R.A.A.)
| | - Stella May Gwini
- School of Public Health and Preventive Medicine Monash University, Melbourne, VIC, Australia (S.M.G.)
- Department of Biostatistics, University Hospital Geelong, Barwon Health, VIC, Australia (S.M.G.)
| | - Katrina M Long
- National Centre for Healthy Ageing, Frankston, VIC, Australia (K.M.L.)
| | - Jordan H Lai
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia (R.A.A., J.H.L., P.J.F., J.Y.)
| | - Gang Chen
- School of Primary and Allied Health Care (K.M.L.), Centre for Health Economics, Monash Business School (G.C.), Monash University, Frankston, VIC, Australia
| | - Grant M Russell
- Department of General Practice (G.M.R.), Monash University, Frankston, VIC, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland, Brisbane, QLD, Australia (M.S.)
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia (R.A.A., J.H.L., P.J.F., J.Y.)
- Department of Endocrinology, Monash Health, Clayton, VIC, Australia (P.J.F., J.Y.)
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia (R.A.A., J.H.L., P.J.F., J.Y.)
- Department of Endocrinology, Monash Health, Clayton, VIC, Australia (P.J.F., J.Y.)
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Gkaniatsa E, Zverkova Sandström T, Rosengren A, Trimpou P, Olsson DS, Lind M, Muth A, Johannsson G, Ragnarsson O. Mortality in Patients With Primary Aldosteronism: A Swedish Nationwide Study. Hypertension 2023; 80:2601-2610. [PMID: 37855142 DOI: 10.1161/hypertensionaha.123.21895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Primary aldosteronism (PA) is associated with increased mortality. The extent to which this phenomenon is affected by sex, age, comorbidities at diagnosis, and different treatment modalities is largely unknown. The objective was to determine all-cause and cause-specific mortality in a population-based cohort of patients with PA and the impact of age at diagnosis, sex, comorbidities, and treatment modalities. METHODS We used national registers to identify patients diagnosed with PA between 1997 and 2019 (n=2419) and controls (n=24 187) from the general population, matched for sex, age, and county of residence. We obtained mortality data from the Cause-of-Death Register. We used Cox regression models, adjusted for socioeconomic factors and diabetes, to estimate adjusted hazard ratios (HRs [95% CI]). RESULTS Overall, 346 (14.3%) patients with PA and 2736 (11.3%) controls died during a median follow-up time of 8.1 years. PA was associated with increased risk from all-cause mortality (HR, 1.23 [95% CI, 1.10-1.38]), death from cardiovascular disease (HR, 1.57 [95% CI, 1.30-1.89]), and stroke (HR, 1.85 [95% CI, 1.16-2.93]). Patients with cardiovascular disease at diagnosis (HR, 1.53 [1.26-1.85]), age >56 years (HR, 1.28 [95% CI, 1.13-1.45]), patients treated with a low dose of a mineralocorticoid receptor antagonist (HR, 1.30 [95% CI, 1.02-1.66]), and untreated patients (HR, 2.51 [95% CI, 1.72-3.67]) had excess mortality. CONCLUSIONS Mortality, mainly due to cardiovascular disease, is increased in patients with PA compared with controls from the general population, particularly in patients aged >56 years, patients with preexisting cardiovascular comorbidities, and patients receiving low dose of a mineralocorticoid receptor antagonist.
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Affiliation(s)
- Eleftheria Gkaniatsa
- Department of Endocrinology (E.G., P.T., D.S.O., G.J., O.R.), Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine (A.R.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Annika Rosengren
- Department of Medicine, Geriatrics and Emergency Medicine (A.R.), Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine (A.R., M.L.), University of Gothenburg, Sweden
| | - Penelope Trimpou
- Department of Endocrinology (E.G., P.T., D.S.O., G.J., O.R.), Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine (A.R.), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel S Olsson
- Department of Endocrinology (E.G., P.T., D.S.O., G.J., O.R.), Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (E.G., P.T., D.S.O., G.J., O.R.), University of Gothenburg, Sweden
- Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (D.S.O.)
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, Institute of Medicine (A.R., M.L.), University of Gothenburg, Sweden
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden (M.L.)
| | - Andreas Muth
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital (A.M.), University of Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Endocrinology (E.G., P.T., D.S.O., G.J., O.R.), Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (E.G., P.T., D.S.O., G.J., O.R.), University of Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Endocrinology (E.G., P.T., D.S.O., G.J., O.R.), Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (E.G., P.T., D.S.O., G.J., O.R.), University of Gothenburg, Sweden
- Sahlgrenska Academy, Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine (O.R.), University of Gothenburg, Sweden
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