Endocrine Abstracts

Introduction: The antihypertensive (AHT) medication choice, and the use of other drugs that affect the blood pressure (BP) have implications on the work up and management strategy of hypertension referrals.

Methods: We collected data from 300 referrals to a specialist hypertension service (sampled from referrals received between March 2023-24).

Results: a) 96.7% of the referrals were from primary care, the rest were from emergency care or another secondary care clinic. b) AHT usage: angiotensin converting enzyme inhibitors - 47.6%, angiotensin receptor blockers - 24%, calcium channel blockers - 53.9%, Thiazide/thiazide like diuretics - 17.7%, Spironolactone - 6.3%, Beta-blockers - 17.3%, alpha-blockers - 17.7%, Loop diuretics - 2.8%, and one patient each on Hydralazine, methyldopa, and moxonidine. c) 54.4% of patients were on antidepressants. This may cause worsening of hypertension, and orthostatic hypotension in this population.¹ Selective Serotonin Reuptake Inhibitors were the most commonly used and they may interfere with primary hyperaldosteronism testing by leading to high renin and aldosterone levels.² d) Other drug classes identified that may also cause a worsening of hypertension were - NSAIDs (9.4%), anti-migraine agents (6.7%), anti-psychotics (4.7%) and glucocorticoids (2.7%). e) The mean number of AHT agents in this population was 1.6. This is lower than 2.6, the average number needed to achieve goal BP in clinical trials.³ The mean SBP was 150.01 mmHg (SD 12.02), which also supports room for up-titration at the point of referral. 45.3% were on a single agent.

Conclusions: This information will be useful for other hypertension services to clarify their local work up strategy for hyperaldosteronism, and will also help in streamlining AHT up-titration.

References1. Calvi A, et al. Front Cardiovasc Med. 2021;8:704281. doi: 10.3389/fcvm.2021.704281.2. Faconti L, et al. J Hum Hypertens. 2024;38(1):8-18. doi: 10.1038/s41371-023-00875-1.3. Yamout H, Bakris GL. Hypertension: A Companion to Braunwald’s Heart Disease. Elsevier; 2018. p. 261-267. ISBN 9780323429733.