High blood pressure service increases referrals

A clinical service and primary care outreach program focused on hormonal causes of high blood pressure — the first of its kind in Victoria — has led to earlier screening and diagnosis of primary aldosteronism.

Dr Jun Yang's clinical service and primary care outreach program has led to earlier screening and diagnosis of primary aldosteronism.
Dr Jun Yang

Primary aldosteronism (PA), or Conn’s Syndrome, is characterised by excessive secretion of the hormone aldosterone from the adrenal glands. This overproduction leads to the retention of sodium in the body, resulting in high blood pressure which is difficult to control.  PA carries a higher risk of heart arrhythmia, heart attacks and strokes than ordinary hypertension.

The Endocrine Hypertension Service at Hudson Institute and Monash Health has facilitated an increase in referrals from general practitioners for primary aldosteronism screening over three years of operation. This has resulted in the earlier diagnosis and treatment of PA. The results were published in the Internal Medicine Journal, the official journal of internal medicine in the Adult Medicine Division of The Royal Australasian College of Physicians, to ensure the findings were distributed widely to doctors around Australia.

PA is the most common secondary cause of hypertension, affecting 5-10 per cent of hypertensive patients in primary care and up to 30 per cent in tertiary centres, based on international studies.

The Endocrine Hypertension Service is the first of its kind in Victoria and one of few in Australia. Over the three years since launching, patients have become less likely to have pre-existing heart or kidney damage at the time of referral, and more likely to improve their blood pressure with fewer medications.

“Our Endocrine Hypertension Service saw a six-fold increase in patients referred for early testing, two-fold decrease in end-organ damage and consistent blood pressure reduction with targeted treatment,” said Dr Jun Yang, the study’s senior author.

“Our study shows that general practitioners are more likely to screen for primary aldosteronism when there is a streamlined diagnostic pathway, such as our Endocrine Hypertension Service, together with an education program,” Dr Yang said.

“Most patients with high blood pressure rely on their GPs for testing and treatment. Increased screening among GPs will lead to more diagnoses and therefore benefit more Victorians/Australians.”

“Our goal is to accurately diagnose every patient affected by PA,” Dr Yang said.

Dr Yang was recently awarded a NHMRC Investigator Grant Emerging Leadership (Level 1) for her research into primary aldosteronism.

More information on primary aldosteronism can be found here.

How science helped Jun Yang’s family

Jun Yang wishes she had more time with her grandfather. He died aged just 56 from a stroke caused by high blood pressure, when Jun was one-year-old.

Dr Jun Yang, Blood Pressure, Primary aldosteronism (PA)
Dr Jun Yang

Dr Yang, an endocrinologist and research scientist with the Cardiovascular Endocrinology Group at Hudson Institute, studies an under-diagnosed cause of high blood pressure in Australia known as primary aldosteronism, or Conn’s Syndrome. With Professor Peter Fuller, she established the Endocrine Hypertension Service at Hudson Institute and Monash Health, which has witnessed a six-fold increase over three years in PA diagnoses.

Dr Yang has diagnosed and treated her father, mother and 94-year-old grandmother with the condition, successfully reducing their high blood pressure levels with a targeted treatment.

Dr Yang’s father takes just one quarter of a tablet, a targeted medicine that blocks aldosterone action, per day for blood pressure. He used to take four pills, and still had poor blood pressure. He has stable kidney function and no heart issues. Her mother is also on a quarter of a tablet with excellent results, and her grandmother’s blood pressure has also reduced with treatment.

Dr Yang can hardly believe the results. She only wishes her research findings ‘could go back in time’, to help her grandfather.

What is primary aldosteronism?

  • Primary aldosteronism or PA is excessive production of the hormone aldosterone from the adrenal glands
  • It causes high blood pressure which is difficult to control
  • Patients have a higher risk of heart arrythmia, heart attacks and strokes
  • It is likely under-diagnosed
  • Overseas data shows somewhere between one in 20 and up to 1 in 10 hypertensive patients have a PA diagnosis

Collaborators | Monash Health; School of Clinical Sciences at Monash Health, Monash University
Funders | CASS Foundation Grant; ESA post-doctoral award; Heart Foundation Vanguard Grant; Council for High Blood Pressure Research Australia Grant

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