Hypertension action bundle including training of healthcare professionals to improve the detection of primary aldosteronism: a cohort study.

The annual incidence of primary aldosteronism (PA) diagnosis per 1000 consultations increased significantly across all three phases of the training programme.

• Annual incidence increased from 1.2 per 1000 consultations in P1 (2016-2018) to 2.64 in P2 (2019-2021) and 4.31 in P3 (2022-2024).
• Odds Ratio for P1 to P2 increase: 2.2 [95% CI, 1.2-4.1].
• Odds Ratio for P2 to P3 increase: 1.6 [95% CI, 1.1-2.4].
• A total of 110 PA patients were diagnosed over the full study period (2016-2024).
• Overall, the training programme improved the likelihood of PA diagnosis by approximately fourfold.

The increase in PA diagnosis was primarily attributed to enhanced screening by general practitioners and cardiologists.

• General practitioners familiarised themselves with screening indications including patients under 40 years of age or with a history of hypokalaemia, even if diuretic-induced.
• For specialists, awareness of the frequency of PA, particularly in aggressive forms of hypertension, was described as decisive.
• Both groups of physicians reported an increase over time in systematic questioning of refractory hypertension.
• The increase was attributed to patient origin shifting toward referrals from GPs and cardiologists over time.

PA screening indications evolved over time, shifting toward less common hypertension profiles in later phases.

• In P2, screening indications were primarily hypokalaemia and hypertension with target organ damage.
• In P3, indications shifted to pre-eclampsia, refractory hypertension, and hypertension in young patients.
• Training of gynaecologists and midwives enabled identification of pregnant women with hypertensive disorders during pregnancy requiring secondary hypertension screening.
• There was little to no change in patients' clinic-biological profile between periods despite the shift in screening indications.

Only approximately 2% of patients with primary aldosteronism are currently diagnosed, despite it being the leading cause of secondary hypertension.

• PA is described as the leading cause of secondary hypertension.
• PA requires targeted treatment to control cardiovascular risk.
• The authors state that 'only 2% of patients with primary hyperaldosteronism are diagnosed.'
• This low diagnosis rate provides context for the clinical importance of the training intervention.

The study used a multidisciplinary, town-hospital approach across three structured phases to deliver the hypertension action bundle.

• P1 (2016-2018): training delivered to hospital practitioners.
• P2 (2019-2021): training extended to practitioners working outside of hospitals.
• P3 (2022-2024): consolidation phase.
• The study investigated patient origin, reason for consultation, and clinical-biological profile to gain insight into the diagnostic process.
• The setting was a blood pressure clinic, and the cohort comprised patients diagnosed with PA between 2016 and 2024.