Abstract P101: Primary Aldosteronism Screening In At-risk Populations

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Winnie Nhan ◽  
Caitlin Urban ◽  
Yuxuan Chen ◽  
Lili Zhao ◽  
Lynn Holevinski ◽  
...  
Keyword(s):  
At Risk ◽  
Primary Aldosteronism ◽  
Adrenal Mass ◽  
Antihypertensive Agents ◽  
Outpatient Setting ◽  
Metabolic Complications ◽  
Obstructive Sleep ◽  
Academic Settings ◽  
At Risk Populations ◽  
End Stage

Background: Primary aldosteronism (PA) is the most common cause of endocrine hypertension. PA is associated with higher rates of cardiovascular, metabolic, and renal comorbidities as compared to equivalent primary hypertension (HTN). Objective: To evaluate the rates and patterns of PA screening across various at-risk populations. Methods: We performed a retrospective review of adult patients seen in a university-based outpatient setting between 1/1/17-6/30/20, who had HTN plus at least one of the following criteria: 1) taking ≥3 antihypertensive agents (resistant HTN); 2) age <35; 3) obstructive sleep apnea (OSA); 4) hypokalemia; or 5) an adrenal mass. We excluded patients with adrenal insufficiency, congenital adrenal hyperplasia, severe renal disease, and end stage heart failure. Results: We identified 93,362 patients (54.6% men, mean age 64±16 y, 82.3% white, 12.8% black, 2.3% Asian) meeting at least one PA screening criterion. Of these, 3.4% were screened for PA. Screening occurred in 2.7% (1,813/66,185) of patients with resistant HTN; 4.2% of those with HTN and OSA (1,297/29,322) or hypokalemia (599/5,387); 5.1% of those <35 y (461/8,573); and 46.5% (452/972) of patients with HTN and an adrenal mass. Multiple logistic regression showed that the odds of screening were highest in patients with hypokalemia: OR: 3.4 (3.2-3.7), and were independent of having atrial fibrillation or myocardial infarction. Among patients with resistant HTN and those with HTN and OSA, women vs. men (OR: 1.2-1.4) and blacks vs. all other races (OR: 2-2.6, p <0.0001 for all) were more likely to be screened. Conversely, among patients <35 y and those with adrenal masses, there were no race or sex differences. Although ~8 years younger, patients with resistant HTN and HTN+OSA screened had higher prevalence of chronic kidney disease, cerebrovascular accidents, dyslipidemia, and diabetes than those not screened. Conclusions: PA remains vastly under-recognized, even in large academic settings. Consideration for PA is given more often after comorbidities have developed. Enhancing awareness and screening rates for PA are critical for preventing cardio-renal and metabolic complications in many patients with HTN.

scholarly journals Rates of Primary Aldosteronism Screening Among High-Risk Populations

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A297-A298
Author(s):  
Seda Grigoryan ◽  
Sonja Marie Konzen ◽  
Adina F Turcu
Keyword(s):  
High Risk ◽  
Primary Aldosteronism ◽  
Secondary Hypertension ◽  
White Americans ◽  
General Internists ◽  
Obstructive Sleep ◽  
High Prevalence ◽  
High Risk Populations ◽  
At Risk Populations ◽  
Adrenal Masses

Abstract Background: Primary aldosteronism (PA) is the most common form of secondary hypertension. PA is associated with higher cardiovascular and renal morbidity and mortality than equivalent essential hypertension. Data on PA screening rates are scarce. Objective: To evaluate the rates of PA screening among at-risk populations. Methods: We conducted a retrospective review of adult patients (age ≥ 18 years) with hypertension (HTN) seen in a University setting outpatient clinics between 2010–2019 who had: 1) resistant HTN; 2) HTN and hypokalemia; 3) HTN at age &lt;40; 4) HTN and known adrenal mass; or 5) HTN and obstructive sleep apnea (OSA). We excluded patients with known high-renin HTN, renovascular HTN, or congenital adrenal hyperplasia. Results: We identified 11,627 patients with HTN meeting at least one of the inclusion criteria. Of these, only 3.27% were ever screened for PA. Patients screened were younger (47.5 ± 17.8 vs. 51.3 ±16.9, p &lt;0.0001), more often women (55.28% vs. 45.71%, p=0.0003), had lower serum K+ (3.4 ± 0.5 vs. 3.7 ± 0.4, p&lt;0.0001), and were more likely to have chronic kidney disease (29.27% vs. 17.5%, p&lt;0.0001) and cerebrovascular accidents (9.21% vs. 6.16%, p= 0.02) than those never screened. While most patients in this cohort were white (79.9% vs. 15.3% black, and 2.3% Asian), screening rates were overall higher in Asian (8.4%) and black (6.1%) than in white Americans (2.8%, p&lt;0.0001). Of the different indications for PA screening, the rates were highest among patients with adrenal nodules (35%) and lowest in patients with HTN and OSA (2.1%). The rates of screening were similar in patients younger vs. older than age 40 (3.2%, p=0.9). Among patients with resistant hypertension, those screened were on average 10 years younger (58.5 ± 14.0 vs. 68.7 ± 12.8, p&lt;0.0001) and twice as often black (20.7% vs. 10.1%) compared to those not screened for PA. Conversely, in patients with adrenal masses, there were no sex, age, or race differences between those screened vs. not screened for PA. PA screening was initiated most often by general internists (53.9%), followed by endocrinologists (15.8%), and rarely by nephrologists (9.5%), or cardiologists (4.2%). Conclusions: Despite its high prevalence and associated cardio-renal morbidity, PA screening is pursued in only 3% of high-risk populations. While patients screened are generally younger and more often black than those not screened, the diagnosis is often suspected after complications have already developed. These data indicate that initiatives to encourage PA screening are crucial for preventing cardiovascular and renal morbidity in many patients with HTN.

Age and marital status predictors of binge alcohol use among adults with major depressive episode

2020 ◽  
Author(s):  
Areen Omary
Keyword(s):  
At Risk ◽  
Alcohol Use ◽  
Marital Status ◽  
Depressive Episode ◽  
Major Depressive Episode ◽  
Age Groups ◽  
Future Research ◽  
Major Depressive ◽  
Never Married ◽  
At Risk Populations

Aims: This study aims to examine if age and marital status can predict the risk for binge alcohol use (BAU) among adults with a major depressive episode (MDE). Methods: Data from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2018 National Survey for Drug Use and Health (NSDUH) were analyzed. The unweighted sample included 6,999 adults representing a weighted population size of 33,900,452.122 in the US. Results and Conclusions: The findings of this retrospective research confirmed that age and marital status significantly predicted BAU in the past month among adults with MDE. Adults with MDE at higher risk for BAU were adults under the age of 50, adults who were never married, and adults who were divorced/separated. Special attention must be paid to those in age groups under 50, never married, and have been separated/divorced who are particularly at-risk for future alcohol abuse. Future research should consider examining additional potential confounders for BAU among other at-risk populations.

scholarly journals Coverage of immediate postpartum long-acting reversible contraception has improved birth intervals for at-risk populations

2020 ◽  
Vol 222 (4) ◽  
pp. S886.e1-S886.e9 ◽  
Author(s):  
Abigail Liberty ◽  
Kimberly Yee ◽  
Blair G. Darney ◽  
Ana Lopez-Defede ◽  
Maria I. Rodriguez
Keyword(s):  
At Risk ◽  
Birth Intervals ◽  
At Risk Populations ◽  
Long Acting

scholarly journals Is there a relationship between sleep apnoea and microalbuminuria?

2021 ◽  
Author(s):  
Melek Cihanbeylerden ◽  
Melike Bağnu Yüceege
Keyword(s):  
Microvascular Complications ◽  
Sleep Apnoea ◽  
Urinary Albumin ◽  
Control Group ◽  
Creatinine Ratio ◽  
Microvascular Damage ◽  
Metabolic Complications ◽  
Albumin Creatinine Ratio ◽  
Obstructive Sleep ◽  
Significant Difference

Abstract Introduction Obstructive sleep apnoea (OSA) is a cause of hypoxia, and the correlation between hypoxia and microvascular complications is well known. Microalbuminuria (MAU) is a marker for endovascular dysfunction and an indicator of cardiovascular events and all-cause mortality in the general population. The aim of this study was to investigate the relationship between microvascular damage and the metabolic complications of OSA based on the presence of MAU. Material and method Urinary albumin/creatinine ratio (ACR) and microalbumin level were examined in patients with an apnoea-hypopnoea index (AHI) greater than 5/h (study group) and in patients with an AHI less than 5/h (control group). The exclusion criteria were other possible causes of MAU (hypertension, nephropathy, coronary artery disease, and severe thyroid dysfunction). Results Of 103 patients enrolled, 80 formed the group with OSA and 23 served as controls. According to the AHI values, the patients were divided into four groups as normal, mild, moderate and severe. There was no significant difference between the four groups in terms of the microalbumin level and urinary albumin/creatinine ratio. Conclusion In this study, no significant relationship was found between MAU and sleep apnoea.

European Respiratory Society Statement on Sleep Apnoea, Sleepiness and Driving Risk

2020 ◽  
pp. 2001272
Author(s):  
Maria R Bonsignore ◽  
Winfried Randerath ◽  
Sofia Schiza ◽  
Johan Verbraecken ◽  
Mark W Elliott ◽  
...  
Keyword(s):  
At Risk ◽  
Motor Vehicle ◽  
Task Force ◽  
Present Report ◽  
Sleep Apnoea ◽  
Accident Risk ◽  
European Respiratory Society ◽  
Obstructive Sleep ◽  
Patients At Risk ◽  
The Impact

Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure (CPAP) has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea-hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk for OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a Task Force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA, the mechanisms involved in this association, the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance, the impact of treatment on MVA risk in affected drivers, and highlights the evidence gaps regarding the identification of OSA patients at risk for MVA.

scholarly journals Identifying subgroups within at-risk populations that drive late HIV diagnosis in a Southern U.S. state

2020 ◽  
pp. 095646242094756
Author(s):  
Sabina O Nduaguba ◽  
Kentya H Ford ◽  
James P Wilson ◽  
Kenneth A Lawson ◽  
Robert L Cook
Keyword(s):  
At Risk ◽  
Older Individuals ◽  
Hiv Diagnosis ◽  
Interaction Terms ◽  
Late Hiv Diagnosis ◽  
Increased Risk ◽  
At Risk Populations ◽  
Sex With Men ◽  
Aids Diagnosis ◽  
Racial Ethnic

We aimed to identify subgroups within age, racial/ethnic, and transmission categories that drive increased risk for late HIV diagnosis (LHD). A 1996–2013 retrospective study of HIV-diagnosed individuals (N = 77,844) was conducted. The proportion of individuals with LHD (AIDS diagnosis within 365 days of HIV diagnosis) was determined, stratified by age, race/ethnicity, and transmission category. Logistic regression with interaction terms was used to identify groups/subgroups at risk for LHD during 1996–2001, 2002–2007, and 2008–2013. Respectively, 78%, 27%, 38%, and 31% were male, White, Black, and Hispanic. Overall, 39% had LHD with a 6.7% reduction for each year increase (OR = 0.93, 95% CI = 0.93–0.94, p < 0.01). Older age was significantly associated with increased odds of LHD (OR range = 1.90–4.55). Compared to their White counterparts, all Hispanic transmission categories (OR range = 1.31–2.58) and only Black female heterosexuals and men who have sex with men (MSM) (OR range = 1.14–1.33) had significantly higher odds of LHD during 1996–2001 and/or 2002–2007. Significance was limited to Hispanic MSM (all age categories), MSM/IDUs (30–59 years), and heterosexuals (18–29 years) and Black MSM (30–39 years) during 2008–2013. Older individuals and Hispanics (driven by MSM) are at increased risk for LHD. HIV testing interventions directed at seniors and Hispanic MSM can further reduce rates of LHD.

scholarly journals Factors Associated with Willingness to Accept Oral Fluid HIV Rapid Testing among Most-at-Risk Populations in China

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e80594 ◽  
Author(s):  
Huanmiao Xun ◽  
Dianmin Kang ◽  
Tao Huang ◽  
Yuesheng Qian ◽  
Xiufang Li ◽  
...  
Keyword(s):  
At Risk ◽  
Oral Fluid ◽  
Willingness To Accept ◽  
Rapid Testing ◽  
Factors Associated ◽  
Hiv Rapid Testing ◽  
At Risk Populations ◽  
Most At Risk Populations

scholarly journals Expanding the Space: Inclusion of Most-at-Risk Populations in HIV Prevention, Treatment, and Care Services

2011 ◽  
Vol 57 ◽  
pp. S96-S99 ◽  
Author(s):  
Chris Beyrer ◽  
Stefan Baral ◽  
Deanna Kerrigan ◽  
Nabila El-Bassel ◽  
Linda-Gail Bekker ◽  
...  
Keyword(s):  
At Risk ◽  
Hiv Prevention ◽  
Care Services ◽  
At Risk Populations ◽  
Most At Risk Populations

scholarly journals Executive Summary: 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis

2016 ◽  
Vol 63 (6) ◽  
pp. 717-722 ◽  
Author(s):  
John N. Galgiani ◽  
Neil M. Ampel ◽  
Janis E. Blair ◽  
Antonino Catanzaro ◽  
Francesca Geertsma ◽  
...  
Keyword(s):  
At Risk ◽  
Infectious Diseases ◽  
Practice Guideline ◽  
Management Strategies ◽  
Systemic Infection ◽  
Western Hemisphere ◽  
Executive Summary ◽  
Valley Fever ◽  
Critical Elements ◽  
At Risk Populations

Abstract It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.

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