Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Am J Hypertens. 2023 Jun 15;36(7):363-371. doi: 10.1093/ajh/hpad022.
Hypertension plus obstructive sleep apnea (OSA) is recommended in some guidelines as an indication to screen for primary aldosteronism (PA), yet prior data has brought the validity of this recommendation into question. Given this context, it remains unknown whether this screening recommendation is being implemented into clinical practice.
We conducted a population-based retrospective cohort study of all adult Ontario (Canada) residents with hypertension plus OSA from 2009 to 2020 with follow-up through 2021 utilizing provincial health administrative data. We measured the proportion of individuals who underwent PA screening via the aldosterone-to-renin ratio by year. We further examined screening rates among patients with hypertension plus OSA by the presence of concurrent hypokalemia and resistant hypertension. Clinical predictors associated with screening were assessed via Cox regression modeling.
The study cohort included 53,130 adults with both hypertension and OSA, of which only 634 (1.2%) underwent PA screening. Among patients with hypertension, OSA, and hypokalemia, the proportion of eligible patients screened increased to 2.8%. Among patients ≥65 years with hypertension, OSA, and prescription of ≥4 antihypertensive medications, the proportion of eligible patients screened was 1.8%. Older age was associated with a decreased likelihood of screening while hypokalemia and subspecialty care with internal medicine, cardiology, endocrinology, or nephrology were associated with an increased likelihood of screening. No associations with screening were identified with sex, rural residence, cardiovascular disease, diabetes, or respirology subspecialty care.
The population-level uptake of the guideline recommendation to screen all patients with hypertension plus OSA for PA is exceedingly low.
一些指南建议高血压合并阻塞性睡眠呼吸暂停（OSA）作为原发性醛固酮增多症（PA）筛查的指征，但先前的数据对这一推荐的有效性提出了质疑。考虑到这一背景，目前尚不清楚这一筛查建议是否已在临床实践中实施。
我们对 2009 年至 2020 年期间安大略省（加拿大）所有患有高血压合并 OSA 的成年居民进行了一项基于人群的回顾性队列研究，通过省级卫生行政数据随访至 2021 年。我们通过醛固酮与肾素比值衡量每年接受 PA 筛查的个体比例。我们还进一步检查了同时伴有低钾血症和难治性高血压的高血压合并 OSA 患者的筛查率。通过 Cox 回归模型评估与筛查相关的临床预测因素。
研究队列包括 53130 名同时患有高血压和 OSA 的成年人，其中只有 634 人（1.2%）接受了 PA 筛查。在高血压、OSA 和低钾血症的患者中，符合条件的筛查患者比例增加到 2.8%。在≥65 岁、高血压、OSA 和处方≥4 种降压药物的患者中，符合条件的筛查患者比例为 1.8%。年龄较大与筛查可能性降低相关，而低钾血症和内科、心脏病学、内分泌学或肾脏病学等亚专业治疗与筛查可能性增加相关。筛查与性别、农村居住、心血管疾病、糖尿病或呼吸亚专业治疗均无关联。
高血压合并 OSA 患者进行 PA 筛查的指南推荐在人群层面的接受程度极低。
