Oral free session 1: Primary aldosteronism and screening
| Wednesday, December 2, 2026 |
| 1:30 PM - 2:30 PM |
Speaker
Dr Francis Slattery
Intern
Centre For Endocrinology And Reproductive Health, Hudson Institute Of Medical Research/st Vincent's Hospital Melbourne
Mineralocorticoid Receptor Antagonists in Low-Renin Hypertension and Primary Aldosteronism: A Cohort Study
Abstract
Background and Aims:
Low-renin hypertension (LRH) is a common but under-recognised hypertension subtype for which standard first-line antihypertensives may be suboptimal. Mineralocorticoid receptor antagonists (MRA) are effective in primary aldosteronism (PA) and may also benefit patients with LRH, but comparative real-world data are limited. We aimed to compare the clinical and biochemical responses to MRA therapy in patients with LRH and PA.
Methods:
We conducted a retrospective single-centre cohort study at a tertiary referral centre in Melbourne, Australia. Patients with PA (positive saline suppression test or suppressed direct renin concentration, aldosterone >550pmol/L and hypokalaemia) and LRH (low/suppressed renin but not meeting other criteria for PA) who received at least 12 months of MRA therapy were included. Clinical endpoints included mean office blood pressure and, defined daily dose (DDD) of MRA and other anti-hypertensives. A complete clinical response was defined as normalisation of blood pressure (<140/90mmHg) without additional anti-hypertensives. Biochemical endpoints included renin concentration and potassium concentration. A complete biochemical response was defined as normalisation of renin (>10mU/L) and potassium (>3.6mmol/L).
Results:
A total of 275 patients were included (34 LRH and 241 PA). Median follow-up was 435 days (395 days for LRH, 448 days for PA). Treatment responses were comparable, despite lower MRA doses in patients with LRH (median DDD 0.67 vs 1.15). Blood pressure reductions did not differ between LRH and PA (Δ systolic 16.3 vs 14.0 mmHg; Δ diastolic 4.8 vs 7.1 mmHg), with comparable increases in renin (Δ9.3 vs 12.0 mU/L). Complete biochemical response occurred in 65.5% of patients with LRH and 71.0% of patients with PA, while complete clinical responses were achieved in 51.7% and 63.5% respectively. Patients with PA had a greater increase in serum potassium (Δ0.43 vs 0.20 mmol/L).
Conclusions:
Patients with LRH and PA demonstrated comparable blood pressure reductions and biochemical responses with MRA therapy. These findings support a pathogenic role for mineralocorticoid receptor activation in the pathophysiology of LRH and suggest that MRA may be an effective targeted treatment strategy for this under-recognised hypertension subtype.
Low-renin hypertension (LRH) is a common but under-recognised hypertension subtype for which standard first-line antihypertensives may be suboptimal. Mineralocorticoid receptor antagonists (MRA) are effective in primary aldosteronism (PA) and may also benefit patients with LRH, but comparative real-world data are limited. We aimed to compare the clinical and biochemical responses to MRA therapy in patients with LRH and PA.
Methods:
We conducted a retrospective single-centre cohort study at a tertiary referral centre in Melbourne, Australia. Patients with PA (positive saline suppression test or suppressed direct renin concentration, aldosterone >550pmol/L and hypokalaemia) and LRH (low/suppressed renin but not meeting other criteria for PA) who received at least 12 months of MRA therapy were included. Clinical endpoints included mean office blood pressure and, defined daily dose (DDD) of MRA and other anti-hypertensives. A complete clinical response was defined as normalisation of blood pressure (<140/90mmHg) without additional anti-hypertensives. Biochemical endpoints included renin concentration and potassium concentration. A complete biochemical response was defined as normalisation of renin (>10mU/L) and potassium (>3.6mmol/L).
Results:
A total of 275 patients were included (34 LRH and 241 PA). Median follow-up was 435 days (395 days for LRH, 448 days for PA). Treatment responses were comparable, despite lower MRA doses in patients with LRH (median DDD 0.67 vs 1.15). Blood pressure reductions did not differ between LRH and PA (Δ systolic 16.3 vs 14.0 mmHg; Δ diastolic 4.8 vs 7.1 mmHg), with comparable increases in renin (Δ9.3 vs 12.0 mU/L). Complete biochemical response occurred in 65.5% of patients with LRH and 71.0% of patients with PA, while complete clinical responses were achieved in 51.7% and 63.5% respectively. Patients with PA had a greater increase in serum potassium (Δ0.43 vs 0.20 mmol/L).
Conclusions:
Patients with LRH and PA demonstrated comparable blood pressure reductions and biochemical responses with MRA therapy. These findings support a pathogenic role for mineralocorticoid receptor activation in the pathophysiology of LRH and suggest that MRA may be an effective targeted treatment strategy for this under-recognised hypertension subtype.
Biography
Francis is a current St Vincent's Hospital Melbourne intern with a keen interest in endocrinology. He is currently working with the Hudson Institute of Medical Research Centre of Endocrinology and Reproductive Health in investigating potential management and diagnostic pathways for low-renin hypertension, an often under-recognised and under-treated condition.
Dr Amelie H. Ohlrogge
Visiting Fellow
The George Institute for Global Health
Time of day, day of week, season and temperature affect hypertension screening
Abstract
Background and aim:
Blood pressure (BP) is influenced by temporal factors, but how this may affect the outcomes of hypertension screening is uncertain. We examined the influence of time of day, day of the week, season and outdoor temperature on measured hypertension prevalence and control in an opportunistic self-screening cohort.
Methods:
Secondary cross-sectional analysis of the cluster-randomised Shop-to-Stop Hypertension trial: adults self-screened at kiosks in 30 hardware stores across New South Wales. Hypertension was defined as ≥140/90 mmHg and/or antihypertensive use; control was assessed at conservative (≤140/90 mmHg) and stricter (≤130/80 mmHg) thresholds. Daily temperatures across the screening period were obtained from each store's nearest Bureau of Meteorology station. Associations were assessed with logistic and linear regression adjusted for personal and area-level socioeconomic covariates. Restricted screening scenarios and temperature mediation were examined.
Results:
Among 42,131 adults (58% men, median age 35 years, IQR 30–50 years), 22% had hypertension: 47% untreated, 37% controlled to ≤140/90 mmHg and 23% to ≤130/80 mmHg. Adjusted odds of control among hypertensives were 36% lower in winter than spring (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.53–0.77, p<0.0001); odds of hypertension were lower on weekends (OR 0.84, 95% CI 0.79–0.90, p<0.0001) and afternoons (OR 0.90 [0.84–0.96], p=0.002). The winter rise in systolic BP was larger in treated individuals (+7.6 versus +3.5 mmHg among untreated individuals, p<0.0001) and in those aged 60 years and above (+9.2 versus +2.7 mmHg in those <60 years, p<0.0001). A summer-only screening scenario detected significantly fewer adults with hypertension (21% versus 22% full-year and 24% in winter). Control was estimated at 43% in summer versus 29% in winter (28% versus 16% at the stricter threshold). Each 10°C rise in mean daily temperature was associated with a 3.4 mmHg decrease in systolic BP and 66% higher odds of control.
Conclusions:
Time of day, day of the week, season and outdoor temperature were associated with hypertension prevalence and control in real-world screening. Seasonal effects were larger at stricter thresholds and in older and treated individuals. Season and ambient temperature should always be considered in the design of screening programmes and monitoring population BP.
Blood pressure (BP) is influenced by temporal factors, but how this may affect the outcomes of hypertension screening is uncertain. We examined the influence of time of day, day of the week, season and outdoor temperature on measured hypertension prevalence and control in an opportunistic self-screening cohort.
Methods:
Secondary cross-sectional analysis of the cluster-randomised Shop-to-Stop Hypertension trial: adults self-screened at kiosks in 30 hardware stores across New South Wales. Hypertension was defined as ≥140/90 mmHg and/or antihypertensive use; control was assessed at conservative (≤140/90 mmHg) and stricter (≤130/80 mmHg) thresholds. Daily temperatures across the screening period were obtained from each store's nearest Bureau of Meteorology station. Associations were assessed with logistic and linear regression adjusted for personal and area-level socioeconomic covariates. Restricted screening scenarios and temperature mediation were examined.
Results:
Among 42,131 adults (58% men, median age 35 years, IQR 30–50 years), 22% had hypertension: 47% untreated, 37% controlled to ≤140/90 mmHg and 23% to ≤130/80 mmHg. Adjusted odds of control among hypertensives were 36% lower in winter than spring (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.53–0.77, p<0.0001); odds of hypertension were lower on weekends (OR 0.84, 95% CI 0.79–0.90, p<0.0001) and afternoons (OR 0.90 [0.84–0.96], p=0.002). The winter rise in systolic BP was larger in treated individuals (+7.6 versus +3.5 mmHg among untreated individuals, p<0.0001) and in those aged 60 years and above (+9.2 versus +2.7 mmHg in those <60 years, p<0.0001). A summer-only screening scenario detected significantly fewer adults with hypertension (21% versus 22% full-year and 24% in winter). Control was estimated at 43% in summer versus 29% in winter (28% versus 16% at the stricter threshold). Each 10°C rise in mean daily temperature was associated with a 3.4 mmHg decrease in systolic BP and 66% higher odds of control.
Conclusions:
Time of day, day of the week, season and outdoor temperature were associated with hypertension prevalence and control in real-world screening. Seasonal effects were larger at stricter thresholds and in older and treated individuals. Season and ambient temperature should always be considered in the design of screening programmes and monitoring population BP.
Biography
Amelie Ohlrogge is a clinician scientist trained in cardiology, with research interests spanning hypertension, atrial fibrillation and population health. Originally from Hamburg, Germany, she is currently a visiting fellow at The George Institute for Global Health and UNSW in Sydney, working under the supervision of Prof Alta Schutte.
Prof Jun Yang
Head Of Endocrine Hypertension Group
Hudson Institute Of Medical Research
Who Gets Screened for Primary Aldosteronism? Findings from 69,128 General Practice Patients
Abstract
Background and aims: Primary aldosteronism (PA) is a common, treatable cause of hypertension affecting up to 15% of patients in primary care. Internationally, PA is substantially underdiagnosed. Data on screening rates in Australian primary care are limited. We therefore aimed to determine the proportion of patients with hypertension attending general practice who had undergone PA screening and identify patient and practice factors associated with screening.
Methods: We conducted a cross-sectional study of electronic health record data from 24 general practices across Victoria, South Australia and Tasmania participating in the CONSEP cluster-randomised controlled trial. Eligible patients for analyses were adults with ≥3 practice visits in the preceding two years and either: (i) ≥2 elevated blood pressure readings on separate occasions; (ii) documented hypertension; or (iii) a current antihypertensive prescription. PA screening was defined by a recorded aldosterone-to-renin ratio (ARR). Associations with screening were examined using regression models adjusted for age and sex and accounting for clustering by practice.
Results: Among 69,128 patients (53.6% female; mean age, 60.7 years [SD, 17.9]), 716 (1.0%) had been screened for PA. Of those screened, 8 (1.1%) met Endocrine Society criteria for likely PA and 271 (37.9%) met modified criteria for possible PA (ARR >70 pmol/mU, or >20 pmol/mU while taking interfering medications). Screening was more likely among patients with hypokalaemia (adjusted odds ratio [aOR], 2.77; 95% CI, 2.02–3.79), resistant hypertension (aOR, 6.19; 95% CI, 4.01–9.55), and those taking antihypertensive medication (aOR, 7.27; 95% CI, 4.89–10.80). The screening rates in these subgroups ranged from 1.7% – 2.6%. Higher socioeconomic status and residence in Victoria were also associated with screening.
Conclusions: The low rates of PA screening in patients attending Australian general practice were comparable to rates identified in different health settings overseas. Patients with high-risk features such as hypokalaemia and resistant hypertension were more likely to be screened, although absolute rates of screening were still low. Pragmatic, system-level strategies are needed to increase PA detection in routine primary care.
Methods: We conducted a cross-sectional study of electronic health record data from 24 general practices across Victoria, South Australia and Tasmania participating in the CONSEP cluster-randomised controlled trial. Eligible patients for analyses were adults with ≥3 practice visits in the preceding two years and either: (i) ≥2 elevated blood pressure readings on separate occasions; (ii) documented hypertension; or (iii) a current antihypertensive prescription. PA screening was defined by a recorded aldosterone-to-renin ratio (ARR). Associations with screening were examined using regression models adjusted for age and sex and accounting for clustering by practice.
Results: Among 69,128 patients (53.6% female; mean age, 60.7 years [SD, 17.9]), 716 (1.0%) had been screened for PA. Of those screened, 8 (1.1%) met Endocrine Society criteria for likely PA and 271 (37.9%) met modified criteria for possible PA (ARR >70 pmol/mU, or >20 pmol/mU while taking interfering medications). Screening was more likely among patients with hypokalaemia (adjusted odds ratio [aOR], 2.77; 95% CI, 2.02–3.79), resistant hypertension (aOR, 6.19; 95% CI, 4.01–9.55), and those taking antihypertensive medication (aOR, 7.27; 95% CI, 4.89–10.80). The screening rates in these subgroups ranged from 1.7% – 2.6%. Higher socioeconomic status and residence in Victoria were also associated with screening.
Conclusions: The low rates of PA screening in patients attending Australian general practice were comparable to rates identified in different health settings overseas. Patients with high-risk features such as hypokalaemia and resistant hypertension were more likely to be screened, although absolute rates of screening were still low. Pragmatic, system-level strategies are needed to increase PA detection in routine primary care.
Biography
Professor Jun Yang is Head of the Endocrine Hypertension Group at the Hudson Institute of Medical Research, a Consultant Endocrinologist at Monash Health, and a Senior Researcher in the Department of Medicine at Monash University in Victoria, Australia. She completed her medical degree with Honours at Monash University in 2001, obtained her Fellowship of the Royal Australasian College of Physicians in 2010, and was awarded a PhD in 2013 for her work on tissue-selective coregulators of the mineralocorticoid receptor. She is an internationally recognized clinician-scientist in endocrine hypertension, with a particular focus on primary aldosteronism and mineralocorticoid receptor–mediated cardiovascular disease. She has authored 170 original publications and established Victoria’s first Endocrine Hypertension Service. She co-leads the Primary Aldosteronism Centre of Excellence and is committed to advancing collaborative research to improve the detection and management of primary aldosteronism and related cardiovascular outcomes.
Dr Matthew Woodhouse
Northern Health
Are We Missing Primary Aldosteronism in Patients with Heart Failure?
Abstract
Background and Aim: Primary aldosteronism (PA) affects 5 - 14% of people with hypertension in primary care and confers greater risk of heart failure than primary hypertension at comparable blood pressure. Early diagnosis and targeted treatment may reduce cardiovascular risk, yet PA remains substantially underdiagnosed. We evaluated the proportion of patients attending heart failure clinics who met guideline criteria for PA screening and the proportion who underwent screening.
Methods: We conducted a retrospective multicentre cohort study of patients attending heart failure clinics at two tertiary hospitals in Victoria in 2024. Heart failure was defined according to 2021 European Society of Cardiology guidelines. Indications for PA screening were assessed using the 2016 Endocrine Society guidelines.
Results: Of 500 patients with heart failure, 343 (69%) had at least one indication for PA screening according to the 2016 Endocrine Society guidelines; these included: treatment with four or more antihypertensive medications (235/343, 69%); blood pressure > 140/90 mmHg despite three antihypertensive medications (189/343, 55%); hypertension with hypokalaemia (102/343, 30%); hypertension and sleep apnoea (67/343, 20%); three measurements of blood pressure greater than 150/100 mmHg (10/343, 3%); hypertension and adrenal incidentaloma (4/343, 1.2%); and hypertension with a family history of early onset (<40 years) hypertension or cerebrovascular accident (2/343, 0.6%). No one had a first degree relative with PA.
A total of 16 patients were screened using the aldosterone to renin ratio, with one patient diagnosed with PA following confirmatory testing.
Conclusion: Despite a high prevalence of indications for PA screening among patients with heart failure, fewer than one in ten eligible patients had been screened. These findings identify a major opportunity to improve PA detection and targeted treatment within heart failure services.
With new guidelines suggesting broader screening, an even greater number of patients would be eligible for testing.
Methods: We conducted a retrospective multicentre cohort study of patients attending heart failure clinics at two tertiary hospitals in Victoria in 2024. Heart failure was defined according to 2021 European Society of Cardiology guidelines. Indications for PA screening were assessed using the 2016 Endocrine Society guidelines.
Results: Of 500 patients with heart failure, 343 (69%) had at least one indication for PA screening according to the 2016 Endocrine Society guidelines; these included: treatment with four or more antihypertensive medications (235/343, 69%); blood pressure > 140/90 mmHg despite three antihypertensive medications (189/343, 55%); hypertension with hypokalaemia (102/343, 30%); hypertension and sleep apnoea (67/343, 20%); three measurements of blood pressure greater than 150/100 mmHg (10/343, 3%); hypertension and adrenal incidentaloma (4/343, 1.2%); and hypertension with a family history of early onset (<40 years) hypertension or cerebrovascular accident (2/343, 0.6%). No one had a first degree relative with PA.
A total of 16 patients were screened using the aldosterone to renin ratio, with one patient diagnosed with PA following confirmatory testing.
Conclusion: Despite a high prevalence of indications for PA screening among patients with heart failure, fewer than one in ten eligible patients had been screened. These findings identify a major opportunity to improve PA detection and targeted treatment within heart failure services.
With new guidelines suggesting broader screening, an even greater number of patients would be eligible for testing.
Biography
Matthew Woodhouse graduated with an MD from The University of Melbourne and is a final year basic physician trainee at Northern Health. He has a keen interest in endocrinology, including Primary Aldosteronism and Metabolic Bone Disease.
