Primary aldosteronism testing in lupus: we are not doing it enough
L-R: Dr Fabien Vincent, A/Prof Jun Yang
A new study published in Lupus Science & Medicine reveals that nearly one-third of patients suffering from systemic lupus erythematosus (SLE, lupus) should undergo testing for primary aldosteronism, yet only a very small proportion actually receive this crucial and simple blood test. This research, conducted by School of Clinical Sciences at Monash Health researchers including endocrinologists, nephrologists and rheumatologists, highlights a significant gap in current clinical practice.
The study emphasises the potential benefits of treating primary aldosteronism in people with lupus , including the reduction of hypertension and cardiovascular disease, which are major contributors to morbidity and mortality in this population.
Associate Professor Jun Yang, a co-author and endocrinologist-scientist based at the School of Clinical Sciences, Monash Health and Hudson Institute of Medical Research, stated, "Primary aldosteronism is the most prevalent endocrine cause of secondary hypertension, with an estimated occurrence ranging from 5% to 14% among hypertensive patients in primary care settings. Importantly, primary aldosteronism can be treated and potentially cured."
The research team followed approximately 300 adults with lupus over a decade at the Monash Health Lupus Clinic, and enrolled in the Australian Lupus Registry & Biobank (ALRB). They found that while about one-third of participants had at least one indication for primary aldosterone testing, only 11% of these patients, that is 3% of the study population, actually underwent the plasma aldosterone to renin ratio (ARR) test.
Lupus is a systemic autoimmune disease. Cardiovascular disease is one of the leading causes of death in people with lupus, who face a two- to three-fold higher risk compared to the general population. With hypertension present in up to 77% of people with lupus, addressing primary aldosteronism could significantly improve outcomes for patients.
Dr Fabien Vincent, a lead-author and clinician-scientist at the School of Clinical Sciences at Monash Health, emphasised the importance of earlier detection and treatment of primary aldosteronism in patients with lupus, particularly when they are on fewer interfering medications. He noted, "More research is needed to improve the detection of this highly modifiable cardiovascular risk factor in the lupus population".
This study marks an important step towards better management of cardiovascular risk in this vulnerable population and underscores the need for increased awareness and updated guidelines to improve testing practices for primary aldosteronism in people suffering from lupus.
About Monash University
Monash University is Australia’s largest university with more than 80,000 students. In the 60 years since its foundation, it has developed a reputation for world-leading high-impact research, quality teaching, and inspiring innovation.
With four campuses in Australia and a presence in Malaysia, China, India, Indonesia and Italy, it is one of the most internationalised Australian universities.
As a leading international medical research university with the largest medical faculty in Australia and integration with leading Australian teaching hospitals, we consistently rank in the top 50 universities worldwide for clinical, pre-clinical and health sciences.
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