Visit time constraints, poor ancillary support, and testing-related logistics were the leading barriers preventing secondary hypertension screening across US practices, with significant variation by physician specialty, practice type, and payer mix.
Key Findings
Background
Secondary hypertension screening is conducted in fewer than 2% of candidates despite expert guideline recommendations.
Hypertension affects almost half of US adults and is a major cause of cardiovascular morbidity and mortality
Expert guidelines recommend screening for secondary hypertension in patients with treatment-resistant hypertension and other high-risk groups
Screening occurs in '<2% of candidates' according to the paper
This gap between guideline recommendation and clinical practice motivated the national survey
Methods
The survey achieved a 67% response rate among randomly selected US physicians across four specialties.
425 of 633 response-eligible physicians completed the survey
Physicians were randomly selected from active members of the American Medical Association
Specialties surveyed included primary care physicians, cardiologists, nephrologists, and endocrinologists
Response rate of 67% was achieved
Results
Visit time constraints were the most commonly reported barrier to secondary hypertension screening, cited by 43.5% of physicians.
Visit time constraints were identified as the leading barrier at 43.5%
Poor ancillary support was the second most reported barrier at 29.4%
Testing-related logistics were reported by 27.5% of physicians
These three barriers were identified as the leading reported barriers across all physician types
Results
Primary care physicians were 10- to 17-fold less likely to be familiar with testing interpretation and subsequent steps compared to nephrologists and endocrinologists.
Familiarity gap spanned a 10- to 17-fold difference between primary care physicians and specialists
Nephrologists and endocrinologists served as the reference groups for this comparison
This finding highlights a significant specialty-based knowledge disparity in secondary hypertension workup
The disparity suggests a need for targeted education initiatives for primary care physicians
Results
Physicians in practices covered largely by Medicare were twice as likely to report poor ancillary support compared to those in practices covered primarily by private health insurance.
The odds of reporting poor ancillary support were approximately two-fold higher for Medicare-heavy practices
Private health insurance coverage was used as the reference comparison group
Payer mix was identified as a significant structural determinant of perceived support resources
This finding suggests insurance coverage composition affects practice-level infrastructure for screening
Results
Private practice physicians were more likely to report reimbursement concerns and poor ancillary support but also more likely to have access to specialists compared to physicians in large medical groups.
Reimbursement concerns: adjusted odds ratio 3.4 (95% CI, 1.6–7.7) for private practice vs. large medical groups
Poor ancillary support: adjusted odds ratio 2.1 (95% CI, 1.3–3.6) for private practice vs. large medical groups
Access to specialists: adjusted odds ratio 4.0 (95% CI, 1.2–13.5) favoring private practice physicians
Practice setting was identified as a key determinant of the type and pattern of barriers experienced
Conclusions
The authors identified optimization of clinic visit duration, ancillary support, education initiatives, and timely specialist access as strategies needed to facilitate personalized hypertension care.
Findings were described as calling 'for measures to address critical barriers in secondary hypertension screening'
Four main strategy domains were identified: clinic visit duration optimization, ancillary support, education, and specialist access
The diversity of barriers across practice types and specialties implies that no single intervention will be sufficient
Personalized hypertension care was framed as the overarching goal of these strategies
What This Means
This research suggests that despite guidelines recommending screening for secondary (treatable) causes of high blood pressure—such as hormonal or kidney-related conditions—fewer than 2% of eligible patients actually receive this screening in the United States. To understand why, researchers surveyed over 400 physicians from four specialties (primary care, cardiology, nephrology, and endocrinology), randomly selected from American Medical Association membership rolls, and achieved a strong 67% response rate. The most common reasons doctors gave for not screening were not having enough time during appointments (cited by 43.5%), lacking adequate staff support (29.4%), and difficulties with the logistics of ordering and following up on tests (27.5%).
The study also found important differences based on physician type and practice setting. Primary care doctors were dramatically less familiar with how to interpret screening tests and what to do next—10 to 17 times less familiar than kidney specialists and hormone specialists. Doctors whose patients were mostly covered by Medicare were about twice as likely to report insufficient support staff compared to those with primarily privately insured patients. Private practice physicians faced more concerns about reimbursement and support staff, but paradoxically had better access to refer patients to specialists than those in large medical group practices.
This research suggests that improving secondary hypertension screening will require multiple targeted approaches rather than a single fix. These include giving doctors more time within clinical visits, improving staffing support, providing better education especially for primary care physicians, and ensuring patients can be referred to specialists in a timely manner. Since secondary hypertension is potentially curable, identifying it more reliably could meaningfully reduce the cardiovascular risks—like heart attack and stroke—that come with uncontrolled high blood pressure.
Turcu A, Salman Z, Kromm S, Zhang L, Zhao L, Suzer-Gurtekin Z, et al.. (2026). Barriers for Secondary Hypertension Screening in the United States: A National Physician Survey.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.126.049858