Abstract P091: Reasons For Uncontrolled Blood Pressure Among US Adults

Introduction: In October 2020, the US Surgeon General issued a Call to Action on hypertension control. We investigated the contribution of lack of awareness, not taking antihypertensive medication and an inadequate antihypertensive medication regimen to uncontrolled blood pressure (BP) among US adults. Methods: We analyzed data for 2,282 participants ≥18 years of age with uncontrolled BP from the 2015-2016 and 2017-2018 National Health and Nutrition Examination Surveys (NHANES). BP was measured three times by a trained physician following a standardized protocol. Uncontrolled BP was defined by systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg. Being aware of having hypertension and antihypertensive medication use were defined by self-report. An inadequate antihypertensive medication regimen was defined as taking antihypertensive medication with uncontrolled BP. Data were weighted to represent the non-institutionalized US population. Results: Among US adults with uncontrolled BP, 34.8% were not aware they had hypertension, 13.8% were aware but not taking antihypertensive medication and 51.4% were aware but taking inadequate antihypertensive medication regimen. US adults 18-39 and 40-49 years of age were more likely to be unaware they had hypertension compared to their counterparts ≥70 years of age (multivariable-adjusted prevalence ratios [PR]: 1.62 [95% CI: 1.26-2.07] and 1.41 [95% CI: 1.02-1.95], respectively). Participants who had a healthcare visit in the past year (PR: 0.60 [95% CI: 0.47-0.77]) and who were obese (PR: 0.69 [95% CI: 0.56-0.85]), had diabetes (PR: 0.56 [95% CI: 0.42-0.76]), chronic kidney disease (PR: 0.59 [95% CI: 0.46-0.75]) and a history of cardiovascular disease (PR: 0.41 [95% CI: 0.27-0.61]) were less likely to be unaware they had hypertension. Among those who were aware they had hypertension, US adults who were 18-39 and 40-49 years of age as compared to those ≥70 years of age were more likely to be not taking antihypertensive medication versus taking inadequate antihypertensive medication regimen (multivariable-adjusted PR: 5.48 [95% CI: 3.17-9.48] and 5.14 [95% CI: 2.28-10.26], respectively). In contrast, non-Hispanic blacks and Hispanics as compared to non-Hispanic whites (PR: 0.71 [95% CI: 0.53-0.94] and 0.72 [95% CI: 0.54-0.96], respectively) and those without a usual place to receive healthcare (PR: 0.70 [95% CI 0.51-0.96]) and who had a healthcare visit in past year (PR: 0.47 [95% CI: 0.35-0.62]) were less likely to be not taking antihypertensive medication versus taking inadequate antihypertensive medication regimen. Conclusion: The majority of US adults with uncontrolled BP were either unaware they had hypertension or were taking an inadequate antihypertensive medication regimen. Interventions are needed to increase hypertension awareness and assess and titrate patients’ antihypertensive medication regimen.

Download Full-text

Reasons for Uncontrolled Blood Pressure Among US Adults: Data From the US National Health and Nutrition Examination Survey

Hypertension ◽

10.1161/hypertensionaha.121.17590 ◽

2021 ◽

Vol 78 (5) ◽

pp. 1567-1576

Author(s):

Swati Sakhuja ◽

Calvin L. Colvin ◽

Oluwasegun P. Akinyelure ◽

Byron C. Jaeger ◽

Kathryn Foti ◽

...

Keyword(s):

Blood Pressure ◽

Health Care ◽

National Health ◽

Antihypertensive Medication ◽

Prevalence Ratio ◽

Uncontrolled Blood Pressure ◽

Health And Nutrition ◽

Care Visit ◽

Hypertension Awareness ◽

Health Care Visit

Identifying subgroups of the population with different reasons for uncontrolled blood pressure (BP) can inform where to direct interventions to increase hypertension control. We determined characteristics associated with not being aware of having hypertension and being aware but not treated with antihypertensive medication among US adults with uncontrolled BP using the 2015 to 2018 National Health and Nutrition Examination Surveys (N=2282). Among US adults with uncontrolled BP, systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, 38.0% were not aware they had hypertension, 15.6% were aware but not treated and 46.4% were aware and treated with antihypertensive medication. After multivariable adjustment, US adults who were 18-39 versus ≥70 years old were more likely (prevalence ratio, 1.49 [95% CI, 1.11–1.99]) and those who had a health care visit in the past year were less likely (prevalence ratio, 0.61 [95% CI, 0.48–0.77]) to be unaware they had hypertension. Among US adults with uncontrolled BP who were aware they had hypertension, those 18 to 39, 40 to 49, 50 to 59, and 60 to 69 versus ≥70 years old were more likely to not be treated versus being treated with antihypertensive medication. Not being treated with antihypertensive medication versus being treated and having uncontrolled BP was less common among those with versus without a usual source of health care (prevalence ratio, 0.69 [95% CI, 0.51–0.94]) and who reported having versus not having a health care visit in past year (prevalence ratio, 0.46 [95% CI, 0.35–0.61]). In conclusion, to increase BP control, interventions should be directed towards populations in which hypertension awareness is low and uncontrolled BP is common despite antihypertensive medication use.

Download Full-text

Trends in Awareness, Antihypertensive Medication Use and Blood Pressure Control by Race and Ethnicity Among Adults with Hypertension in the United States: A National Health and Nutrition Examination Analysis from 2011 to 2018

10.1101/2021.08.18.21262251 ◽

2021 ◽

Author(s):

Yuan Lu ◽

Yuntian Liu ◽

Lovedeep S Dhingra ◽

Daisy Singh Massey ◽

Cesar Caraballo ◽

...

Keyword(s):

United States ◽

Blood Pressure ◽

Ethnic Differences ◽

National Health ◽

Antihypertensive Medication ◽

Medication Use ◽

Health And Nutrition ◽

Hypertension Awareness ◽

And Control ◽

Racial Ethnic

Objective: To examine United States (US) trends in racial/ethnic differences in hypertension awareness and antihypertensive medication use, and whether these differences help explain racial/ethnic differences in hypertension control among adults from 2011 to 2018. Design: Population-based study. Setting: National Health and Nutrition Examination Survey (NHANES), 2011-2018. Participants: A nationally representative sample of US adults aged 18 years or older. Main outcome measures: Hypertension awareness was defined as self-reported physician diagnosis of hypertension. Antihypertensive treatment was based on self-reported use of antihypertensive agents. Blood pressure (BP) control was measured systolic BP <140 mmHg and diastolic BP <90 mmHg. Results: This study included 8,095 adults with hypertension from NHANES 2011-2018. During the study period, age-adjusted hypertension awareness declined from 84.0% (95% confidence interval 79.5 to 86.2) to 77.5% (74.0 to 80.5), hypertension treatment declined from 77.3% (73.4 to 81.1) to 71.4% (69.0 to 73.8) and control rates declined from 51.9% (47.1 to 56.7) to 43.1% (39.7 to 46.5). These declines were consistent for Black, Hispanic, and White individuals, but the three outcomes increased or did not change for Asian individuals. Compared with White individuals, Black individuals did not have a significantly different awareness (odds ratio:1.20 [0.96 to 1.45]) and overall treatment rate (1.04 [0.84 to 1.25]), but received more antihypertensive medications if treated (1.41 [1.27 to 1.56]), and had a lower BP control rate (0.72 [0.61 to 0.83]); Asian and Hispanic individuals had significantly lower awareness rates (0.69 [0.52 to 0.85] and 0.74 [0.59 to 0.89], respectively), overall treatment rates (0.72 [0.57 to 0.88] and 0.69 [0.55 to 0.82]), received fewer medications if treated (0.60 [0.50 to 0.72] and 0.86 [0.75 to 0.96]), and had lower BP control rates (0.66 [0.54 to 0.79] and 0.69 [0.57 to 0.81]). The racial/ethnic differences in awareness, treatment, and BP control persisted over the study period and were consistent across age, sex, and income strata. Lower awareness and treatment were associated with lower BP control in Asian and Hispanic individuals, but not in Black individuals. Conclusions: Hypertension awareness, treatment, and control declined from 2011-2018, and this decline was consistent for Black, Hispanic, and White individuals. BP control was worse for Asian, Black, and Hispanic individuals than for White individuals over the entire study period; this was explained partly by differences in awareness and treatment for Asian and Hispanic individuals, but not for Black individuals.

Download Full-text

Is the Association of Diabetes With Uncontrolled Blood Pressure Stronger in Mexican Americans and Blacks Than in Whites Among Diagnosed Hypertensive Patients?

American Journal of Hypertension ◽

10.1093/ajh/hpt109 ◽

2013 ◽

Vol 26 (11) ◽

pp. 1328-1334 ◽

Cited By ~ 9

Author(s):

Xuefeng Liu ◽

Ping Song

Keyword(s):

Blood Pressure ◽

Racial Differences ◽

Mexican Americans ◽

The United States ◽

Linear Regression Models ◽

Uncontrolled Blood Pressure ◽

Hypertensive Patients ◽

Health And Nutrition ◽

Multistage Design ◽

Hispanic White

Abstract BACKGROUND Clinical evidence shows that diabetes may provoke uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of diabetes with uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated. METHODS A total of 6,134 diagnosed hypertensive subjects aged ≥20 years were collected from the National Health and Nutrition Examination Survey 1999–2008 with a stratified multistage design. Odds ratios (ORs) and relative ORs of uncontrolled BP and effect differences in continuous BP for diabetes over race/ethnicity were derived using weighted logistic regression and linear regression models. RESULTS Compared with participants who did not have diabetes, non-Hispanic black participants with diabetes had a 138% higher chance of having uncontrolled BP, Mexican participants with diabetes had a 60% higher chance of having uncontrolled BP, and non-Hispanic white participants with diabetes had a 161% higher chances of having uncontrolled BP. The association of diabetes with uncontrolled BP was lower in Mexican Americans than in non-Hispanic blacks and whites (Mexican Americans vs. non-Hispanic blacks: relative OR = 0.55, 95% confidence interval (CI) = 0.37–0.82; Mexican Americans vs. non-Hispanic whites: relative OR = 0.53, 95% CI = 0.35–0.80) and the association of diabetes with isolated uncontrolled systolic BP was lower in Mexican Americans than in non-Hispanic whites (Mexican Americans vs. non-Hispanic whites: relative OR = 0.62, 95% CI = 0.40–0.96). Mexican Americans have a stronger associaton of diabetes with decreased systolic BP and diastolic BP than non-Hispanic whites, and a stronger association of diabetes with decreased diastolic BP than non-Hispanic blacks. CONCLUSIONS The association of diabetes with uncontrolled BP outcomes is lower despite higher prevalence of diabetes in Mexican Americans than in non-Hispanic whites. The stronger association of diabetes with BP outcomes in whites should be of clinical concern, considering they account for the majority of the hypertensive population in the United States.

Download Full-text

Effects of eplerenone on resistance to antihypertensive medication in patients with primary or secondary hyperaldosteronism

Journal of Translational Internal Medicine ◽

10.1515/jtim-2017-0020 ◽

2017 ◽

Vol 5 (2) ◽

pp. 93-99 ◽

Cited By ~ 1

Author(s):

J. David Spence ◽

Chrysi Bogiatzi ◽

Mariya Kuk ◽

George K. Dresser ◽

Daniel G. Hackam

Keyword(s):

Blood Pressure ◽

Resistant Hypertension ◽

Concomitant Medication ◽

Antihypertensive Medication ◽

Pressure Control ◽

Blinded Study ◽

History Of ◽

Secondary Hyperaldosteronism ◽

One Year ◽

Resistance Score

Abstract Background and Objectives Resistant hypertension is an important problem; nearly half of diagnosed hypertensives are not controlled to target blood pressure levels, and approximately 90% of strokes occur among patients with resistant hypertension. Primary aldosteronism accounts for approximately 20% of resistant hypertension, but the role of secondary hyperaldosteronism in resistant hypertension is seldom considered. We assessed the effects of eplerenone in patients with hypertension and either primary or secondary hyperaldosteronism. Methods Patients with a history of resistant hypertension and a supine plasma aldosterone level ≥ 360 pmol/L were randomized to eplerenone versus placebo in a fully blinded study for one year. A medication intensity score was developed to assess the resistance of hypertension to medication (blood pressure × medication intensity). We assessed the effects of eplerenone on blood pressure and on resistance to concomitant medication. Results Final results were available in 37 patients (19 on eplerenone and 18 on placebo). Resistance to medication, as assessed by the intensity of concomitant medication required to maintain blood pressure control, was markedly reduced by eplerenone: medication intensity scores declined by –0.50 ± 1.04 (SD) on placebo versus –2.11 ± 1.45 with eplerenone (P = 0.0001), the Systolic Resistance Score declined by –80.00 ± 122.93 on placebo versus –334.05 ± 21.73 on eplerenone (P = 0.0001), and the Diastolic Resistance Score increased by 1.28 ± 31.65 on placebo and declined by –40.74 ± 57.08 on eplerenone (P = 0.009). Conclusions Eplerenone significantly reduced resistance to concomitant antihypertensive medication in both primary and secondary hyperaldosteronism.

Download Full-text

Abstract WP155: Is Erectile Dysfunction More Frequent Among Men with History of Stroke: Analysis of National Health and Nutrition Examination Surveys 2001 to 2004

Stroke ◽

10.1161/str.48.suppl_1.wp155 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Adnan I Qureshi ◽

Sher Afgan ◽

Muhammad A Saleem

Keyword(s):

Erectile Dysfunction ◽

National Health ◽

The United States ◽

Severe Disability ◽

Self Report ◽

Stroke Survivors ◽

Health And Nutrition ◽

History Of ◽

Nationally Representative ◽

Physician Diagnosis

Background: A common question among men who are stroke survivors is whether stroke occurrence will interfere with sexual performance. The question continues to have major significance in resumption of normal activities and reintegration into society for stroke survivors. Methods: Using a standard questionnaire, we examined trends and prevalence of erectile dysfunction in regards to moderate (sometimes) to severe (always) disability to get and keep an erection adequate for satisfactory intercourse in a nationally representative sample of the United States population. We analyzed data from 4929 men who participated in National Health and Nutrition Examination Survey (NHANES) 2001 to 2004. Stroke was defined based on self-report of physician diagnosis. Results: Moderate to severe disability to get and keep an erection adequate for satisfactory intercourse was reported by 13 (6.4%) men with history of stroke and 276 (5.8%) without stroke, respectively (p=0.65). After adjustment for differences in age, men with history of stroke did not have any increase in risk of moderate to severe disability to get and keep an erection adequate for satisfactory intercourse (odds ratio [OR] 0.8; 95% confidence interval [CI] 0.4 to1.7). Conclusions: Erectile dysfunction was relatively infrequent among men with history of stroke and no higher than in men without stroke.

Download Full-text

May Measurement Month 2019: an analysis of blood pressure screening results from Colombia

European Heart Journal Supplements ◽

10.1093/eurheartj/suab039 ◽

2021 ◽

Vol 23 (Supplement_B) ◽

pp. B46-B48

Author(s):

Patricio Lopez-Jaramillo ◽

Jose P Lopez-Lopez ◽

Johanna Otero ◽

Natalia Alarcon-Ariza ◽

Margarita Mogollon-Zehr ◽

...

Keyword(s):

Blood Pressure ◽

Antihypertensive Medication ◽

Hypertension Detection ◽

Middle Income ◽

Middle Income Countries ◽

The Third ◽

Hypertension Awareness ◽

Low Levels ◽

And Control ◽

Implementing Strategies

Abstract Hypertension awareness and control is poor in low- and middle-income countries. Thus, implementing strategies to increase hypertension detection is needed. Colombia participated as one of the 92 countries involved in the third campaign of the May Measurement Month in 2019. Blood pressure (BP) was measured in 48 324 volunteers from 13 departments in Colombia. In total, 27.9% individuals were identified with hypertension. Of those with hypertension, 63.7% were aware of their condition, 60.0% were on antihypertensive medication, and 38.4% had controlled BP. These results showed low levels of awareness, treatment, and control of hypertension in this sample of subjects volunteered to participate, suggest the urgent necessity of implementing programmes to improve the diagnosis and management of hypertension in Colombia.

Download Full-text

Associated factors with awareness, treatment and control of hypertension among 3,579 hypertensive adults in China: data from the China Health and Nutrition Survey

10.21203/rs.3.rs-18826/v1 ◽

2020 ◽

Author(s):

junxiang Wei ◽

Bo Xin ◽

Yan Li ◽

Youfa Wang

Keyword(s):

Blood Pressure ◽

Associated Factors ◽

Eastern Region ◽

Chinese Adults ◽

Nutrition Survey ◽

Antihypertensive Medications ◽

Public Health Burden ◽

Health And Nutrition ◽

Hypertension Awareness ◽

And Control

Abstract Background: Hypertension prevalence is high and rising in China, but it is inadequately controlled. This study investigated hypertension awareness, treatment, and control and their associated factors among Chinese adults. Methods: Data collected from the 2011 China Health and Nutrition Survey (CHNS) from 12,991 Chinese adults were used. Hypertension was defined as systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, self-reported prior diagnosed hypertension, or taking antihypertensive medications. Hypertension awareness, treatment, and control were defined as a self-reported diagnosis of hypertension, current use of antihypertensive medication, and blood pressure < 140/90 mm Hg, respectively. Multivariate logistic regression was performed to examine factors associated with hypertension awareness, treatment, and control. Results: Overall, 3,579 (27.6%) of the CHNS adult participants had hypertension, of whom 55.7% were aware of their diagnosis, 46.5% were treated with antihypertensive medications, but only 20.3% had their blood pressure controlled. Rates of hypertension awareness and treatment varied across population subgroups; higher likelihood was associated with being female (OR = 1.37; 95%CI, 1.12-1.66), older age (1.57; 1.65-4.02), urban residence (1.50; 1.14-1.97), living in the Eastern region (1.52; 1.14-2.01), having overweight/obesity (1.99; 1.39-2.84), and engaging in less healthy lifestyles. Lower control rate was associated with obesity (0.56; 0.42-0.76) and minority ethnicity (0.52; 0.31-0.86). Conclusion: Hypertension is a major public health burden in China. Rates of hypertension awareness, treatment, and control are still low despite efforts that have been made. More intensive screening and treatment intervention programs are needed in the future.

Download Full-text

Association Between Self-Reported Hypertension and Antihypertensive Medication Use and Cardiovascular Disease–Related Events and Expenditures Among Patients Diagnosed With Hypertension

Public Health Reports ◽

10.1177/0033354919864363 ◽

2019 ◽

Vol 134 (5) ◽

pp. 493-501

Author(s):

Madeleine M. Baker-Goering ◽

David H. Howard ◽

Julie C. Will ◽

Garrett R. Beeler Asay ◽

Kakoli Roy

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Disease ◽

High Blood Pressure ◽

Antihypertensive Medication ◽

Medication Use ◽

Medical Expenditures ◽

Self Report ◽

Related Event ◽

Predicted Probability

Objectives: Research suggests that persons who are aware of the risk factors for cardiovascular disease (CVD) are more likely to engage in healthy behaviors than persons who are not aware of the risk factors. We examined whether patients whose insurance claims included an International Classification of Diseases, Ninth Revision (ICD-9) code associated with hypertension who self-reported high blood pressure were more likely to fill antihypertensive medication prescriptions and less likely to have CVD-related emergency department visits and hospitalizations (hereinafter, CVD-related events) and related medical expenditures than patients with these codes who did not self-report high blood pressure. Methods: We used a large convenience sample from the MarketScan Commercial Database linked with the MarketScan Health Risk Assessment (HRA) Database to identify patients aged 18-64 in the United States whose insurance claims included an ICD-9 code associated with hypertension and who completed an HRA from 2008 through 2012 (n = 111 655). We used multivariate logistic regression analysis to examine the association between self-reported high blood pressure and (1) filling prescriptions for antihypertensive medications and (2) CVD-related events. Because most patients with hypertension will not have a CVD-related event, we used a 2-part model to analyze medical expenditures. The first part estimated the likelihood of a CVD-related event, and the second part estimated expenditures. Results: Patients with an ICD-9 code of hypertension who self-reported high blood pressure had a significantly higher predicted probability of filling antihypertensive medication prescriptions (26.5%; 95% confidence interval, 25.7-27.3; P < .001), had a significantly lower predicted probability of a CVD-related event (0.6%, P < .001), and on average spent significantly less on CVD-related events ($251, P = .01) than patients who did not self-report high blood pressure. Conclusion: This study affirms that self-knowledge of high blood pressure, even among patients who are diagnosed and treated for hypertension, can be improved. Interventions that improve patients’ awareness of their hypertension may improve antihypertensive medication use and reduce adverse CVD-related events.

Download Full-text

The Association between Antihypertensive Medication Use and Blood Pressure Is Influenced by Obesity

Journal of Obesity ◽

10.1155/2018/4573258 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Jash S. Parikh ◽

Arshdeep K. Randhawa ◽

Sean Wharton ◽

Heather Edgell ◽

Jennifer L. Kuk

Keyword(s):

Blood Pressure ◽

Ace Inhibitors ◽

Antihypertensive Medication ◽

Medication Use ◽

Normal Weight ◽

Antihypertensive Medications ◽

Glucose Levels ◽

Health And Nutrition ◽

Obesity Status ◽

Main Effects

Introduction. One in three US adults is living with obesity or hypertension, and more than 75% of hypertensive individuals are using antihypertensive medications. Therefore, it is important to examine blood pressure (BP) differences in populations that are using these medications with differing obesity status. Aim. We examined whether BP attained when using various antihypertensive medications varies amongst different body mass index (BMI) categories and whether antihypertensive medication use is associated with differences in other metabolic risk factors, independent of BMI. Methods. Adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 were used (n=15,285). Linear regression analyses were used to examine the main effects and interaction between antihypertensive use and BMI. Results. In general, users of antihypertensive medications had lower BP than those not taking BP medications (NoBPMed) (P<0.05), whereby in women, the differences in systolic BP between angiotensin-converting-enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) users and NoBPMed were greater in those with obesity (ACE inhibitors: −14 ± 1 mmHg; ARB: −16 ± 1 mmHg) compared to normal weight individuals (ACE inhibitors: −9 ± 1 mmHg; ARB: −11 ± 1 mmHg) (P<0.05). Diastolic BP differences between women ARB users and NoBPMed were also greatest in obesity (−5 ± 1 mmHg) (P<0.05) whilst there were no differences in normal weight individuals (−1 ± 1 mmHg) (P>0.05). Furthermore, glucose levels and waist circumference in women were higher in those using ACE inhibitors compared to diuretics (P<0.05). Conclusion. ACE inhibitors and ARBs may be associated with more beneficial BP profiles in women with obesity, with no obesity-related BP differences for antihypertensive medication in men. However, there could be potential cardiometabolic effects for some antihypertensive medications that should be explored further.

Download Full-text

Aldosterone to Renin Ratio as a Screening Instrument for Primary Aldosteronism in a Middle-Aged Population with Atrial Fibrillation

Hormone and Metabolic Research ◽

10.1055/s-0043-119220 ◽

2017 ◽

Vol 49 (11) ◽

pp. 831-837 ◽

Cited By ~ 2

Author(s):

Georgios Mourtzinis ◽

Ahmad Ebrahimi ◽

Helena Gustafsson ◽

Gudmundur Johannsson ◽

Karin Manhem

Keyword(s):

Atrial Fibrillation ◽

Blood Pressure ◽

Primary Aldosteronism ◽

Screening Instrument ◽

Risk Profile ◽

Cardiovascular Risk Profile ◽

Uncontrolled Blood Pressure ◽

History Of ◽

Aldosterone To Renin Ratio ◽

Low Cardiovascular Risk

AbstractAtrial fibrillation seems to be overrepresented among patients with primary aldosteronism. The aim of this study was to determine the usefulness of aldosterone to renin ratio as a screening instrument for primary aldosteronism in an atrial fibrillation population with relatively low cardiovascular risk profile. A total of 149 patients <65 years and with history of AF were screened for primary aldosteronism using aldosterone to renin ratio. Pathologically increased aldosterone to renin ratio (>65 pmol/mIU) was found in 15 participants (10.1%). Further investigation of the positive screened participants and confirmatory saline infusion test resulted in a diagnosis of primary aldosteronism in four individuals out of 149 (2.6%). Three out of the four individuals with primary aldosteronism had previously been diagnosed with hypertension, but only one out of the four had uncontrolled blood pressure, that is, >140/90 mmHg. All participants had normal potassium levels. Individuals with increased aldosterone to renin ratio had significantly higher mean systolic and diastolic blood pressure in comparison to participants with normal aldosterone to renin ratio (136 vs. 126 mmHg, p=0.02 and 84 vs. 78 mmHg, p=0.02). These findings suggest that assessment of aldosterone to renin ratio can be useful for identification of underlying primary aldosteronism in patients with diagnosed atrial fibrillation and hypertension in spite of well controlled blood pressure and normokalemia.

Download Full-text