Primary aldosteronism (PA) is the most common cause of secondary hypertension. (1, 2, 3, 4) It is characterized by renin-independent aldosterone production from one or both adrenal glands which is inappropriately high for sodium status. (3) PA can be cured with surgery if it is secondary to unilateral disease and treated medically if both adrenal glands are the culprit. (3, 4, 5) People with untreated PA have an increased risk of stroke, coronary artery disease, atrial fibrillation, heart failure, and chronic kidney disease compared to those with primary hypertension who have an equivalent degree of blood pressure (BP) control.(6, 7) Early diagnosis of PA can facilitate targeted therapy, which is critical to reduce PA-associated comorbidities. (5, 8, 9)

Up to 25% of people with resistant hypertension (RH) have PA.(3, 4, 10, 11) RH is defined as elevated blood pressure despite concurrent use of 3 antihypertensive agents of different classes or controlled BP on 4 or more antihypertensive medications. (12, 13) The diagnosis of RH requires confirmation of the medication dose, medication adherence, accurate BP measurement and out-of clinic BP elevation. When these factors are unable to be confirmed, the term apparent treatment RH (aTRH) is used. Guidelines recommend that all people with resistant hypertension should be screened for PA. (2, 12, 13) However, screening rates remain very low and have been reported to be <2.0%. (14-17

The objectives of this study were to (1) characterize the clinical and demographic characteristics of people with aTRH in our academic healthsystem and (2) develop a non-interruptive BPA and assess if implementation of the BPA in the EHR improved the screening rate for PA among people with aTRH.