Implementation of a Spanish-language, direct-to-patient primary aldosteronism testing program.

Abstract

Primary aldosteronism (PA) is a common, targetable cause of hypertension and cardiovascular risk, but <2% of eligible patients are tested, and Hispanic/Latino patients are underrepresented in PA research and care. We expanded a nationwide, direct-to-patient PA testing program to reach Spanish-speaking adults. Spanish-speaking adults with PA testing indications were recruited from Boston, New York, Miami, Houston, and Los Angeles/San Diego. Participants underwent virtual medical history review in Spanish and local phlebotomy for PA testing, with laboratory interpretations communicated to patients and clinicians. Participants were followed up at 6 months. The primary outcome was the frequency of a positive PA test. Secondary outcomes included clinical PA testing, initiation of aldosterone-targeted therapies, and quality of life. The study population (N = 155) spoke fluent Spanish, with 77.4% reporting limited English proficiency. Of the participants, 30.3% tested positive for PA. Leading PA testing indications were family history of premature hypertension or stroke and sleep apnea. Among participants who tested positive and provided follow-up (n = 29), 10.3% underwent additional testing for PA, and 10.3% started a mineralocorticoid receptor antagonist. Participants cited access to care and clinician dismissal of results as barriers to clinical action; however, study participation was positively rated to enhance health awareness and interest in research participation. This Spanish-language, direct-to-patient PA testing program effectively reached patients for testing, identified possible PA in over 30%, and influenced downstream care. Language-concordant PA testing initiatives can help to address the high prevalence of hypertension and PA in the US Hispanic/Latino population.