Study: Treatable Cause of High Blood Pressure Often Ignored

People whose blood pressure is hard to control might have another condition that’s the real culprit. So why aren’t they being tested for primary aldosteronism?

5:00 AM

Author | Haley Otman

Stethscope and pills
Getty Images

A new study highlights a chicken-or-the-egg scenario in blood pressure management: Testing for a disease that's associated with difficult-to-control blood pressure isn't happening, possibly because providers think it's rare or unwieldy, but if more people were tested, experts say we'd discover it's not rare at all.

The findings are frustrating but not surprising, says co-senior author J. Brian Byrd, M.D., M.S., an assistant professor and cardiologist at the Michigan Medicine Frankel Cardiovascular Center. Byrd, an expert on hypertension, worked with several colleagues at the University of Pennsylvania and Stanford University.

LISTEN UP: Add the new Michigan Medicine News Break to your Alexa-enabled device, or subscribe to our daily updates on iTunes, Google Play and Stitcher

"We're all taught in medical school that if a patient has high blood pressure and low levels of potassium in the blood, or if a patient isn't seeing improvement after blood pressure treatment, you should check for primary aldosteronism," Byrd says. "It's universally taught that this is a definitive cause of high blood pressure in some people, so we wanted to see how commonly this testing is done."

Byrd and colleagues reviewed data from military veterans diagnosed with treatment-resistant hypertension at a Veterans Health Administration facility between 2000 and 2017. They found that fewer than 2% of the people who should've been evaluated for primary aldosteronism were tested. The chances of receiving a needed evaluation were higher when the patient also saw a specialist such as a nephrologist or an endocrinologist to discuss their hypertension.

The most recent blood pressure guideline, from the American Heart Association and American College of Cardiology, recommends testing for the condition in the same situations Byrd said are taught in medical schools.

"There's an educational gap there where some physicians may think it's too complicated to test people for this, or don't know they should be thinking about testing people," Byrd explains. "The most important take-home message for clinicians is: if you're really struggling to control a patient's blood pressure, consider getting a hypertension expert involved who has special training."

SEE ALSO: Specialist: New Hypertension Guidelines Will Facilitate Earlier Intervention

In his clinic, Byrd has seen many patients who hadn't yet been diagnosed with primary aldosteronism, which means blood pressure continued to be uncontrolled, putting them at risk of strokes or heart attacks.

"The frustrating part is that there are effective treatments for primary aldosteronism," Byrd says. "But if no one diagnoses it, it can't be treated, and it's also harder to study primary aldosteronism when it's so rarely diagnosed."

Byrd says current estimates suggest that around 20% of people with uncontrolled hypertension despite taking three blood pressure medications may actually be struggling with this treatable disorder.

If you're really struggling to control a patient's blood pressure, consider getting a hypertension expert involved who has special training.
James Brian Byrd, M.D.

Management of primary aldosteronism depends on the type diagnosed, and may include medications to block the effect of aldosterone in the adrenal gland, or surgery to remove one of the two adrenal glands.

In addition to encouraging conversations with specialists when dealing with uncontrolled blood pressure, the researchers suggest exploring technology to help solve this problem. That could include an automatic alert prompted in patients' electronic health record when they meet conditions to warrant an evaluation for primary aldosteronism, Byrd says.

Paper cited: "Testing for Primary Aldosteronism and Mineralocorticoid Receptor Antagonist Use Among U.S. Veterans." Annals of Internal Medicine. DOI: 10.7326/M20-4873

More Articles About: Body Work Hypertension and High Blood Pressure Cardiovascular: Preventive Cardiology Lab Tests Cardiovascular: Diseases & Conditions
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories heart organ yellow blue
Health Lab
Around 10% of deaths from coronary stenting, balloon angioplasty are preventable
Around 10% of all deaths following percutaneous coronary intervention are potentially preventable, a study led by Michigan Medicine finds.
Microscopic image of bone marrow with pink and white hues
Health Lab
Novel risk score for cardiovascular complications after bone marrow transplant
More bone marrow transplants, also known as hematopoietic stem cell transplantation, are being offered to older patients, a population at greater risk of cardiovascular disease.
dna strand
Health Lab
Female genetic markers may have greater effect on hypertension, certain cardiovascular diseases
Female genetic markers may have greater effect on hypertension, certain cardiovascular diseases
Person's hand holding an aspirin tablet with a glass of water nearby
Health Lab
An aspirin a day? Some older adults who take it may be following outdated advice
Many people aged 50 to 80 who said they take aspirin multiple times a week may not need to do so and could be causing health risks, according to National Poll on Healthy Aging.
Adult performs CPR on a young athlete, illustration with red and blue figures
Health Lab
Sudden cardiac arrest in young athletes: 5 things parents should know
Sudden cardiac arrest in young athletes: 5 things parents should know
Provider takes a pulse oximetry reading from a patient's finger
Health Lab
Inaccurate pulse oximeter readings could limit transplants, heart pumps for Black patients with heart failure
Racially biased readings of oxygen levels in the blood using pulse oximeters may further limit opportunities for Black patients with heart failure to receive potentially lifesaving treatments, such as heart pumps and transplants