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Cardiovascular Endocrinology

SAT-278 - Factors Associated with Screening for Primary Aldosteronism: A National Retrospective Cohort Study.

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT
Location: ENDOExpo; Poster Floor


Background: The prevalence of primary hyperaldosteronism (PA) is estimated at 5-14% in patients with hypertension in primary care, and up to 30% in referral centers. With untreated PA more than doubling the risk of adverse cardiovascular and kidney events, optimizing screening and diagnosis is essential. In this study, we aim to quantify the rate of PA screening across the U.S. and identify the multi-level factors associated with PA screening.

Method: This is a retrospective cohort study of claims data from Optum Labs Data Warehouse, inclusive of commercial and Medicare Advantage plans across the U.S. Study cohort included adults >18 years with incident hypertension (years 2011-2023), excluding patients with preexisting adrenal disorders or prior PA diagnosis/screening. We calculated the proportion of patients screened for PA with both plasma renin and aldosterone within 7 days. Logistic regression modelling was then used to identify sociodemographic and clinical factors associated with screening.

Result: Of 2,462,320 eligible adults, 18,787 (0.76%) were screened for PA. The screening rate was low (0.3-1.8%) across all sociodemographic and clinical characteristics, with slightly higher rates among young adults 18-25 years (3.2%), when diagnosing provider was endocrinology (3.1%) or nephrology (2.6%) and in patients with adrenal mass (6.4%). Factors independently associated with greater odds of screening were: Asian race (vs White; OR 1.17, 95% CI [1.09-1.26]), annual income ≥ $200,000 (vs < $40,000; OR 1.47,[1.36-1.59]),hypokalemia (OR 1.49,[1.34-1.66]), potassium supplementation (OR 1.66, [1.50-1.84]), having a adrenal mass (OR 5.64, [ 1.83-17.36]), getting care from endocrinology (vs primary care; OR 0.4.25,[3.89-4.64]) and diagnosis of resistant hypertension (OR 1.89,[1.65-2.15]). Patients odds of screening decreased with age up to >75years (vs 18-25 years; OR 0.10, [0.09- 0.12]), male (vs female; OR 0.67,[0.65-0.69]), education less than 12th grade (vs more than bachelor’s degree; OR 0.59, [0.48-0.72]), living in a nonmetropolitan area (vs metropolitan; OR 0.74, [0.66-0.83]), history of smoking (OR 0.83,[0.77-0.91]), atrial fibrillation (OR 0.70, [0.62-0.79]), heart failure (OR 0.67,[0.57-0.79]), diabetes (OR 0.73,[0.69- 0.77]) and obesity (OR 0.67,[0.64-0.70]). Use of antihypertensive medication except for renin angiotensin aldosterone system inhibitors and diuretics was associated with higher odds for screening for PA.

Conclusion: This is the largest contemporary assessment of PA screening across the U.S., revealing exceptionally low screening rates and key associated factors. Multistakeholder engagement is needed to understand barriers to screening and develop sustainable strategies to efficiently and effectively screen for, diagnose, and ultimately treat PA.

*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.*