Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia (R.A.A., J.H.L., P.J.F., J.Y.).
School of Public Health, Imperial College London, United Kingdom (R.A.A.).
Hypertension. 2024 Feb;81(2):348-360. doi: 10.1161/HYPERTENSIONAHA.123.21965. Epub 2023 Dec 14.
Primary aldosteronism (PA) is a common but underdiagnosed cause of hypertension. Many patients experience preventable end-organ injury due to delayed or missed diagnosis but data on the experience of patients are limited.
We evaluated the lived experience of PA and determines factors associated with diagnostic delay through an international anonymous online cross-sectional survey, codesigned by researchers and PA consumers. We distributed the survey through academic medical centers, Amazon Mechanical Turk, Twitter, PA patient advocacy groups, and hypertension support groups on Facebook between March 21 and June 5, 2022.
Of 684 eligible respondents, 66.5% were women. Diagnostic delay (defined as ≥5 years between the diagnosis of hypertension and PA) was reported in 35.6%. Delay was more likely in women than in men (odds ratio, 1.55 [95% CI, 1.10-2.20]) and respondents with ≥3 comorbidities versus none (odds ratio, 1.77 [95% CI, 1.05-3.02]), ≥10 symptoms versus none (odds ratio, 2.73 [95% CI, 1.74-4.44]), and on ≥4 antihypertensive medications versus none (odds ratio, 18.23 [95% CI, 6.24-77.72]). Three-quarters of patients (74.4%) experienced reduced symptom burden following targeted PA treatment. Quality of life improved in 62.3% of patients, and greater improvement was associated with being a woman (odds ratio, 1.42, [95% CI, 1.02-1.97]), receiving adrenalectomy (odds ratio, 2.36 [95% CI, 1.67-3.35]), and taking fewer antihypertensive medications following diagnosis (odds ratio, 5.28 [95% CI, 3.55-7.90]).
One-third of patients with PA experienced prolonged diagnostic delays. Targeted treatment led to reduced symptom burden and improved quality of life. Gender differences in diagnostic delay and symptom burden are prominent. These findings suggest that routine screening for PA at the onset of hypertension may reduce diagnostic delay and facilitate timely diagnosis.
原醛症（PA）是一种常见但未被充分诊断的高血压病因。许多患者由于诊断延误或漏诊而导致可预防的靶器官损伤，但有关患者体验的数据有限。
我们通过一项由研究人员和 PA 患者共同设计的国际匿名在线横断面调查，评估了 PA 的患者体验，并确定了与诊断延迟相关的因素。我们于 2022 年 3 月 21 日至 6 月 5 日期间，通过学术医疗中心、亚马逊土耳其机器人、Twitter、PA 患者权益组织以及 Facebook 上的高血压支持小组，分发了该调查。
在 684 名符合条件的受访者中，有 66.5%为女性。35.6%的患者报告存在诊断延迟（定义为高血压和 PA 诊断之间的时间间隔≥5 年）。与男性相比，女性更有可能出现延迟（优势比，1.55 [95%置信区间，1.10-2.20]），与无合并症相比，合并≥3 种合并症（优势比，1.77 [95%置信区间，1.05-3.02]）、≥10 种症状而非无（优势比，2.73 [95%置信区间，1.74-4.44]）以及使用≥4 种降压药物而非无（优势比，18.23 [95%置信区间，6.24-77.72]）的患者更有可能出现诊断延迟。四分之三的患者（74.4%）在接受靶向 PA 治疗后症状负担减轻。62.3%的患者生活质量改善，女性（优势比，1.42 [95%置信区间，1.02-1.97]）、接受肾上腺切除术（优势比，2.36 [95%置信区间，1.67-3.35]）和诊断后使用更少降压药物的患者（优势比，5.28 [95%置信区间，3.55-7.90]）改善更明显。
1/3 的 PA 患者存在诊断延迟。针对 PA 的治疗可减轻症状负担并改善生活质量。诊断延迟和症状负担方面存在明显的性别差异。这些发现表明，在高血压起始时常规筛查 PA 可能会减少诊断延迟并促进及时诊断。
