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Prevalence of apparent treatment-resistant hypertension and screening rates for primary aldosteronism in an asian ambulatory care setting

Journal of Human Hypertension (2025)Cite this article

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Abstract

Apparent treatment-resistant hypertension (aTRH) is linked to significantly elevated cardiovascular risk and unfavorable long-term outcomes. Despite guideline recommendations to screen for primary aldosteronism (PA) in patients with aTRH, the prevalence of screening in Asian ambulatory care settings remains unknown. This cross-sectional study evaluated hypertensive adults who were managed in the ambulatory clinics of a tertiary hospital in Thailand between January 2020 and May 2023. aTRH was defined by: (1)uncontrolled office blood pressure (BP ≥ 140/90 mmHg) despite maximally tolerated doses of three antihypertensive drug classes, including a diuretic, or (2)use of four or more antihypertensive classes regardless of BP control. PA screening was performed using plasma aldosterone concentration and plasma renin activity measurements. Among 3207 hypertensive patients identified via ICD-10 (I10) coding, 2047 met inclusion criteria after excluding 1160 based on the exclusion criteria; the prevalence of aTRH was 9.4%. The mean age of the aTRH group was 74 ± 10 years, 59% were female, and the average number of antihypertensive agents was 3.8 ± 0.7. PA screening was conducted in only 3.1% of patients with aTRH and 17.9% of hypokalemia, with a median delay of 9.5 (21.25) months from the detection of hypokalemia to PA testing. Among 20 screened patients, five were diagnosed with PA, leading to improved BP control with targeted therapy. This study represents the first real-world analysis of PA screening practices in an Asian ambulatory care population. Strategies to enhance PA screening and address barriers to its implementation are warranted to improve clinical outcomes.

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Fig. 1: Consort diagram of the study.
Fig. 2: Venn diagram illustrating the characteristics of patients in the cohort.

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Data availability

The datasets used and/or analyzed during this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors acknowledge the support for article processing from the Cardiac Center, King Chulalongkorn Memorial Hospital and the use of ChatGPT for checking and editing the grammar of the sentences in this manuscript.

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Author notes

  1. These authors contributed equally: Tanawin Suksiriworaboot, Arun Yacharad.

Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Tanawin Suksiriworaboot

  2. Department of Internal Medicine, Yala Regional Hospital, Yala, Thailand

    Arun Yacharad

  3. Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Weerapat Kositanurit

  4. Division of Hospital and Ambulatory medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Yongkasem Vorasettakarnkij

  5. Division of Endocrinology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Sarat Sunthornyothin

  6. Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Apichard Sukonthasarn

  7. Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Pairoj Chattranukulchai

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  1. Tanawin Suksiriworaboot
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Contributions

TS, AY and WK wrote the manuscript. WK and PC created the figures. TS, YV, SS, AS, and PC were involved in the study design. TS and AY participated in data collection. TS, AY and YV performed the data analysis. YV is an essentially intellectual contributor, involved in the research design, data analysis, conclusions and recommendations. All authors have reviewed and approved the final manuscript.

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Correspondence to Weerapat Kositanurit.

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Suksiriworaboot, T., Yacharad, A., Kositanurit, W. et al. Prevalence of apparent treatment-resistant hypertension and screening rates for primary aldosteronism in an asian ambulatory care setting. J Hum Hypertens (2025). https://doi.org/10.1038/s41371-025-01105-6

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