Medical therapy for primary aldosteronism achieved a complete biochemical response in 58.3% and a complete clinical response in 20.8% of patients at ≥12 months.
Cohort (n=1,292)
Yes
Does medical treatment with mineralocorticoid receptor antagonists and epithelial sodium channel blockers improve long-term biochemical and clinical outcomes in adults with primary aldosteronism?
Targeted medical therapy for primary aldosteronism delivers sustained biochemical and clinical benefits beyond 12 months, with early detection and adequate dose titration being key determinants of success.
BACKGROUND: Primary aldosteronism (PA) is a common and treatable cause of hypertension, yet data on the durability of medical treatment response beyond the first year are limited. Using the PA medical treatment outcomes framework, we evaluated long-term biochemical and clinical outcomes and factors associated with treatment response. METHODS: We conducted an international, multicenter, observational cohort study across 27 centers on 4 continents. Adults with PA treated with mineralocorticoid receptor antagonists and epithelial sodium channel blockers between 2016 and 2021 were included if follow-up data were available at ≥12 months. Biochemical and clinical responses were classified as complete, partial, or absent using PA medical treatment outcomes criteria. Ordinal logistic regression identified determinants of a favorable treatment response. RESULTS: The cohort included 1292 patients (47.5% women, mean age 52 years) with a median follow-up of 34 months (interquartile range, 21-51). At ≥12 months, 58.3% achieved a complete biochemical response, and 20.8% achieved a complete clinical response, with only 5% showing no response. Determinants of a favorable biochemical response included lower aldosterone and lateralization index, and higher renin and potassium levels at baseline. In those taking spironolactone, a higher daily dose was also associated with a favorable biochemical response. Determinants of a favorable clinical response included female sex, lower body mass index, shorter duration of hypertension, and absence of hypertension-mediated organ damage. CONCLUSIONS: Targeted medical therapy for PA can deliver sustained biochemical and clinical benefits. Early disease detection and adequate dose titration are highly actionable determinants of long-term treatment success.
Yang et al. (Wed,) conducted a cohort in Primary aldosteronism (n=1,292). Mineralocorticoid receptor antagonists and epithelial sodium channel blockers was evaluated on Complete biochemical response at ≥12 months. Medical therapy for primary aldosteronism achieved a complete biochemical response in 58.3% and a complete clinical response in 20.8% of patients at ≥12 months.