Evidence map›Paper›PMID 39981578›Full record

ArticleHypertension (Dallas, Tex. : 1979)2025

Nationwide, Pragmatic, Direct-to-Patient Primary Aldosteronism Testing Program.

Jenifer M Brown, Laura C Tsai, Eva E Abel, Arnaldo Ferrebus, Anna E Moore, Yvonne M Niebuhr, Bassil Bacare, Brooke Honzel, Julia Milks, Kristen Foote and 3 more

Abstract read
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In one paragraph

Article in Hypertension (Dallas, Tex. : 1979), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed.

  1. Race and Ancestry in Primary Aldosteronism.Journal of the American Heart Association · 2026
    Article
  2. Article
  3. Primary aldosteronism.Nature reviews. Disease primers · 2026
    Review
  4. Article
  5. Review
  6. Hypertensive Disorders of Pregnancy and Primary Aldosteronism.Hypertension (Dallas, Tex. : 1979) · 2026
    Article
  7. Is It Time to Retire Aldosterone Suppression Testing?American journal of hypertension · 2026
    Review
  8. Hypertensive Disorders of Pregnancy and Primary Aldosteronism.medRxiv : the preprint server for health sciences · 2026
    Article
  9. Article
  10. Review
  11. Article
  12. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

Jenifer M BrownDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.ORCID 0000-0002-6647-639X
Laura C TsaiDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.ORCID 0009-0008-5344-2589
Eva E AbelDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.
Arnaldo FerrebusDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.
Anna E MooreDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.
Yvonne M NiebuhrDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.
Bassil BacareDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.
Brooke HonzelDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.ORCID 0009-0005-2824-903X
Julia MilksDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.
Kristen FooteDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.
Andrew J NewmanDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.ORCID 0000-0002-8326-1964
Wasita W ParksookDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.ORCID 0000-0001-7963-9621
Anand VaidyaDivision of Endocrinology, Diabetes, and Hypertension, Center for Adrenal Disorders (J.M.B., L.C.T., E.E.A., A.F., A.E.M., Y.M.N., B.B., B.H., J.M., K.F., A.J.N., W.W.P., A.V.), Harvard Medical School, Boston, MA.ORCID 0000-0002-0314-9252

Funding

TRAINING PROGRAM IN HYPERTENSIONT32HL007609 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI ADLER, GAIL KURR · 1985 to 2022
$10.2M
Unrecognized Primary Aldosteronism as a Pathogenic Mechanism for Chronic Kidney Disease in DiabetesR01DK115392 · NIDDK · BRIGHAM AND WOMEN'S HOSPITAL · PI Anand Vaidya · 2018 to 2026
$6.0M
Adrenal Origins of Aldosterone ExcessR01DK106618 · NIDDK · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI William E Rainey, Aaron Mark Udager · 2016 to 2026
$6.0M
Aldosterone, the Mineralocorticoid Receptor, and Cardiovascular Disease in ObesityR01HL153004 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI VAIDYA, ANAND · 2020 to 2024
$4.4M
Primary Aldosteronism Subtypes: Pathophysiology and Steroid SignaturesR01HL155834 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI TURCU, ADINA F · 2021 to 2025
$3.5M
Cardiac Perfusion, Structure, and Function across the Primary Aldosteronism SpectrumK23HL159279 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI Jenifer Michelle Brown · 2022 to 2026
$1.0M
NHLBI NIH HHS K23 HL159279NHLBI NIH HHS R01 HL153004NHLBI NIH HHS R01 HL155834NHLBI NIH HHS T32 HL007609NIDDK NIH HHS R01 DK106618NIDDK NIH HHS R01 DK115392
6 · The paper itself

Abstract

backgroundPrimary aldosteronism, an endocrinopathy present in ≥10% to 25% of patients with hypertension, confers excess cardiovascular risk that can be mitigated with aldosterone-directed therapy. However, only 2% of eligible patients undergo guideline-recommended screening. This study aimed to bypass clinical inertia and identify people with primary aldosteronism using pragmatic, direct-to-patient testing.

methodsHypertensive adults were recruited via online platforms and underwent virtual consent and local phlebotomy. Using a standardized diagnostic algorithm, laboratory results with interpretations were communicated to patients and primary care providers. Follow-up was ascertained at 6 to 12 months. The primary outcome was the frequency of a positive test for primary aldosteronism. Secondary outcomes included follow-up primary aldosteronism testing and implementation of aldosterone-targeted therapies.

resultsThe study population (N=694) had a mean age of 63.3±11.3 years, was 52.2% female, and hailed from 41 US states. Overall, 25.4% had a positive test for primary aldosteronism. Sleep apnea, resistant hypertension, and hypokalemia were the most common testing indications, with 55.2% of participants having ≥2 indications. Over half of participants (57%) were already under endocrinology, cardiology, or nephrology care, yet had not been tested. In longitudinal follow-up of participants with a positive result, 25.5% had additional testing, 13.7% were started on aldosterone-targeted therapy (mineralocorticoid receptor antagonist or adrenalectomy), and 24.5% reported improved blood pressure control.

conclusionsPragmatic, direct-to-patient testing, and simplified results interpretation is a feasible, scalable method to increase primary aldosteronism diagnoses and implementation of aldosterone-targeted therapies. Given that new hypertension guidelines recommend primary aldosteronism screening in all hypertensive people, practical approaches to test, interpret, and implement results will be essential.

Indexed as

HyperaldosteronismHypertensionMass ScreeningAgedAldosteroneFemaleHumansMaleMiddle AgedUnited StatesAldosteronealdosteroneblood pressurehyperaldosteronismhypertensionsocial media

Identifiers

PMID39981578
PMCPMC12078016

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.