Primary Aldosteronism Screening Cost-Effective in Resistant Hypertension

(HealthDay News) — For patients with resistant hypertension, computed tomography (CT) scanning followed by adrenal venous sampling is a cost-effective screen for primary aldosteronism, according to a study published in Circulation: Cardiovascular Quality and Outcomes.

Carrie C. Lubitz, MD, MPH, from Massachusetts General Hospital in Boston, and colleagues examined whether the long-term cardiovascular (CV) benefit of identifying and treating surgically correctable primary aldosteronism outweighs the increased upfront costs. 

A decision-analytic model was used to compare aggregate costs and systolic blood pressure changes for 6 diagnostic strategies for primary aldosteronism in a simulated population of at-risk patients with resistant hypertension. A seventh strategy whereby all patients were treated with a mineralocorticoid-receptor antagonist without further testing was also evaluated. 

Changes in systolic blood pressure were converted into gains in quality-adjusted life-years (QALYs); incremental cost-effectiveness ratios were calculated using QALYs and lifetime costs.

The researchers found that, compared with treating all, the incremental cost-effectiveness ratio for CT followed by adrenal venous sampling was $82 000 per QALY. For CT alone and adrenal venous sampling alone, the incremental cost-effectiveness ratios were $200 000 per QALY and $492 000 per QALY, respectively; other strategies were less effective and more costly.

“Primary hyperaldosteronism is a common disease that is currently, grossly underdiagnosed and treated,” the researchers wrote. “Our results suggest that CT followed by [adrenal venous sampling] is a cost-effective strategy to screen for [primary aldosteronism] among patients with [resistant hypertension].”


  1. Lubitz CC, Economopoulos KP, Sy S, et al. Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients. Circ Cardiovasc Qual Outcomes. 2015;doi:10.1161/CIRCOUTCOMES.115.002002.