Mineralocorticoid receptor antagonist therapy in primary aldosteronism yielded complete clinical success in 16.2% and complete biochemical response in 50.1% of patients.
Cohort (n=402)
Yes
Do baseline clinical and biochemical parameters predict treatment response to mineralocorticoid receptor antagonists in patients with primary aldosteronism?
In patients with primary aldosteronism treated with MRAs, complete clinical and biochemical responses are achieved in a minority and half of patients respectively, with specific baseline predictors identifying those most likely to respond.
BACKGROUND: Data on factors predicting favorable response to medical therapy in primary aldosteronism, based on Primary Aldosteronism Medical treatment Outcome (PAMO) criteria, remain limited. AIM: This study aimed to identify baseline parameters independently associated with clinical and biochemical responses to mineralocorticoid receptor antagonist (MRA) therapy after at least 6 months of treatment. METHODS: Primary aldosteronism patients from the SPAIN-ALDO registry, treated medically with MRA (or amiloride) and with available clinical and/or biochemical follow-up data after at least 6 months of therapy were included. RESULTS: A total of 402 patients (38.3% women; mean age 57 ± 11.8 years) were analyzed. Median follow-up duration was 38 months interquartile range (IQR) 20-76. At last visit, 55% of patients were receiving spironolactone, 44% eplerenone, and 1.2% amiloride. Among 389 patients with clinical follow-up data, 16.2% achieved complete clinical success, 65.5% partial response, and 18.3% showed no response. Complete clinical response was more likely in women, in patients with lower BMI, fewer antihypertensive medications, and higher potassium levels. Among 261 patients with biochemical follow-up data, 50.1% had complete biochemical response, 21.5% partial, and 28.4% absent. Predictors of complete biochemical response included lower baseline aldosterone concentration, higher baseline renin levels, use of spironolactone rather than eplerenone, and higher MRA doses. CONCLUSION: Early identification of primary aldosteronism and optimized titration of MRA therapy, especially with eplerenone, are crucial for improving clinical and biochemical outcomes.
Goi et al. (2026) conducted a cohort in Primary aldosteronism (n=402). Mineralocorticoid receptor antagonist (MRA) therapy was evaluated on Clinical and biochemical responses to MRA therapy. Mineralocorticoid receptor antagonist therapy in primary aldosteronism yielded complete clinical success in 16.2% and complete biochemical response in 50.1% of patients.