PRACTICE PATTERNS IN A SPECIALIST HYPERTENSION CLINIC
ARUNIMA JAIN1,2, ANDREW CHUNG2, CAMILA E RODRIGUES1,2,3, AMY KANG1,2,4, ZOLTAN ENDRE1,2, SRADHA KOTWAL1,2,4
1Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia
2University of New South Wales, Sydney, New South Wales, Australia
3Department of Nephrology, Hospital das Clínicas, Sao Paolo, Brazil
4The George Institute for Global Health, Sydney, New South Wales, Australia
Abstract
Aim: To describe practice patterns and diagnoses from a specialist hypertension clinic.
Background: Hypertension is a treatable risk factor for cardiovascular and kidney disease. Limited local data describe management and outcomes from specialist hypertension clinics.
Methods: Patient records between August 2020-December 2022 were reviewed. Primary outcome was the proportion of patients with secondary causes of hypertension. Data were analysed using Student’s t-tests and Mann-Whitney U-tests respectively for parametric and non-parametric continuous variables, and Fisher’s exact tests for categorical variables.
Results: Data for 62/63 patients were reviewed; one referred patient did not attend. Fifty-seven patients had results investigating secondary causes including: aldosterone and renin levels (55), catecholamine metabolites (49), and kidney imaging (49). Two of the remaining patients were lost to follow-up and three did not meet criteria for resistant or young-onset hypertension.
Secondary causes of hypertension were diagnosed in 14 patients including primary aldosteronism (7/14; five were referred for adrenalectomy, two had bilateral adrenal hyperplasia), renovascular disease (3/14), and kidney disease (4/14; one newly diagnosed). Two patients with secondary hypertension were also diagnosed with sleep apnoea, with median STOP-BANG score 3 (intermediate risk; interquartile range (IQR) 2-4) in 47/62 patients. Twenty-seven patients were diagnosed with essential hypertension; remaining patients had investigations pending or were lost to follow-up.
Patient characteristics including age, sex, antihypertensive class, office blood pressure and comorbidities (stroke, diabetes, cardiovascular and kidney disease) were similar between patients with and without secondary hypertension. Median follow-up duration was three months (IQR 2-6).
Conclusions: Systematic screening of selected patients streamlined diagnoses of secondary hypertension, with no major differences between those with primary or secondary hypertension. Our further work aims to determine cost-effectiveness and long-term patient outcomes.
Biography
Dr Arunima Jain is a Nephrology Fellow at the Prince of Wales Hospital in Sydney. Her clinical and research interests include hypertension, acute kidney injury and obstetric medicine.