SAT-275 - Closing the Screening Gap: Improving Detection of Primary Aldosteronism in Patients with Hypertension and Obstructive Sleep Apnea

Primary aldosteronism (PA) is a common cause of hypertension, affecting an estimated 10–25% of patients with hypertension, yet fewer than 1% are diagnosed. Untreated PA is associated with cardiovascular and renal morbidity, including stroke, atrial fibrillation, coronary artery disease, chronic kidney disease, and heart failure. Patients with obstructive sleep apnea (OSA) and hypertension represent a particularly high‑risk population, for whom current Endocrine Society guidelines recommend routine screening. This quality improvement initiative aimed to evaluate baseline PA screening rates among patients with hypertension and OSA in endocrine, primary care, and sleep medicine clinics within our health system, and to improve screening through targeted educational interventions.
Adult patients aged ≥18 years with ICD‑10 codes for hypertension and OSA confirmed by polysomnography were identified through electronic health record (EHR) review. Patients with renal artery stenosis, decompensated heart failure, or pregnancy were excluded. Baseline PA screening rates were defined by completion of plasma aldosterone, renin, and calculation of aldosterone‑to‑renin ratio between January and December 2024. A survey was distributed across participating clinics to identify barriers to screening. Interventions included clinician education on guideline‑based screening, laboratory interpretation, standardized testing workflows, as well as clarification of appropriate indications for endocrinology referral. Screening rates were reassessed over a three-month period following these interventions.
Survey responses revealed limited awareness of the association between PA and OSA, as well as uncertainty regarding laboratory ordering and interpretation of results. At baseline, only 14 of 171 patients (5%) underwent screening. Among those screened, one patient met diagnostic criteria for PA, and four had suppressed renin levels ( < 1 mg/ml/h). Following implementation of interventions, PA screening was ordered for 14 of 109 patients (13%). Of these, eight patients completed laboratory testing, and one patient met criteria for PA.
Screening for PA among patients with hypertension and OSA was strikingly low in our health system. Notably, a substantial proportion of screened patients demonstrated suppressed renin, suggesting a higher burden of undiagnosed PA than reflected by confirmed diagnoses alone. A targeted educational intervention more than doubled screening rates (5% to 13%). Our intervention required minimal resources and is readily scalable across healthcare systems. Although causality cannot be established in this pre–post design, the observed improvement was temporally associated with implementation of the intervention. Broader adoption of similar interventions could meaningfully improve screening and prevent cardiovascular and renal complications.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*