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Cardiovascular Endocrinology

SUN-252 - Non-Adherence to Antihypertensive Medications in Primary Aldosteronism: A Prospective Cohort Study

Sunday, June 14, 2026
9:00 AM - 4:00 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Shaohong Wang, BSc: No financial relationships to disclose
Purpose
Patients with primary aldosteronism (PA) often have resistant hypertension, and are at greater risk of cardiovascular morbidity. Hence, aldosterone-specific treatment is necessary. However, poor adherence to antihypertensive treatment may underline suboptimal blood pressure control in PA patients. This study aimed to determine the prevalence of non-adherence, and factors associated with non-adherence to antihypertensive medication among patients with PA.

Methods
This prospective cohort study enrolled consecutive patients diagnosed with PA. Patients underwent subtyping with computed tomography and adrenal vein sampling. Patients with unilateral PA were managed with unilateral adrenalectomy and those with bilateral PA, or not keen for surgery were treated with medical therapy. The final study visit was at 12 months post-treatment during which a random urine sample was obtained and analyzed for the presence of 26 antihypertensive medications. Non-adherence was defined as an absence of a prescribed medication in the urine sample. Univariable and multivariable logistic regression were performed to identify factors associated with non-adherence.

Results
A total of 45 patients (mean age 57.2 ± 9.3 years, 26.7% female) were included. Twenty-eight (62.2%) were treated with medical therapy and 17 (37.8%) with unilateral adrenalectomy. Of the 45 patients, 13 (28.9%) were non-adherent. Compared to adherent patients, those non-adherent were younger (52.7 ± 8.1 vs 59.0 ± 9.2 years, p=0.048), more likely to have undergone adrenalectomy (61.5% vs 28.1%, p=0.042), and were prescribed fewer antihypertensive medications post-treatment (1.2 ± 1.2 vs 2.2 ± 1.4, p=0.040). In addition, non-adherent patients demonstrated smaller reductions in daytime systolic blood pressure after treatment (+3.9 ± 21.1 vs −13.6 ± 16.2 mmHg, p=0.012), and higher post-treatment daytime diastolic blood pressure (91.8 ± 13.2 vs 83.2 ± 8.4 mmHg, p=0.019). On multivariable analysis, independent predictors of non-adherence were smaller reductions in daytime systolic blood pressure after treatment (adjusted OR 1.07, 95% confident interval (CI) 1.02–1.13, p=0.008) and surgical treatment for PA (adjusted OR 7.18, 95% CI 1.39–37.16, p=0.019). This model yielded an area under receiver-operating characteristic curve of 0.834 (95% CI: 0.667-0.968).

Conclusion
Antihypertensive medication non-adherence is prevalent among patients treated for PA. Surgical management and suboptimal post-treatment blood pressure improvement were independently associated with non-adherence. Patients with PA treated with surgery, or those who do not achieve blood pressure improvement after treatment are more likely to have medication non-adherence and this can help inform doctors to adherence to medications in these patients.

*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.*