Prevalence of apparent treatment-resistant hypertension and screening rates for primary aldosteronism in an asian ambulatory care setting.

Apparent treatment-resistant hypertension (aTRH) is linked to significantly elevated cardiovascular risk and unfavorable long-term outcomes. Despite guideline recommendations to screen for primary aldosteronism (PA) in patients with aTRH, the prevalence of screening in Asian ambulatory care settings remains unknown. This cross-sectional study evaluated hypertensive adults who were managed in the ambulatory clinics of a tertiary hospital in Thailand between January 2020 and May 2023. aTRH was defined by: (1)uncontrolled office blood pressure (BP ≥ 140/90 mmHg) despite maximally tolerated doses of three antihypertensive drug classes, including a diuretic, or (2)use of four or more antihypertensive classes regardless of BP control. PA screening was performed using plasma aldosterone concentration and plasma renin activity measurements. Among 3207 hypertensive patients identified via ICD-10 (I10) coding, 2047 met inclusion criteria after excluding 1160 based on the exclusion criteria; the prevalence of aTRH was 9.4%. The mean age of the aTRH group was 74 ± 10 years, 59% were female, and the average number of antihypertensive agents was 3.8 ± 0.7. PA screening was conducted in only 3.1% of patients with aTRH and 17.9% of hypokalemia, with a median delay of 9.5 (21.25) months from the detection of hypokalemia to PA testing. Among 20 screened patients, five were diagnosed with PA, leading to improved BP control with targeted therapy. This study represents the first real-world analysis of PA screening practices in an Asian ambulatory care population. Strategies to enhance PA screening and address barriers to its implementation are warranted to improve clinical outcomes.