Real-World Effectiveness of Mineralocorticoid Receptor Antagonists in Primary Aldosteronism

Tezuka, Yuta; Turcu, Adina F.

doi:10.3389/fendo.2021.625457

Cited by 12 publications

(7 citation statements)

References 51 publications

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“…More aggressive up-titration of MR antagonists has been shown to provide greater improvements in BP and albuminuria ( 30 ) and may have led to improvements in subclinical systolic dysfunction in our patients. It has to be noted that medical treatment may be fraught with dose-limiting side effects, leading to suboptimal dosages and efficacy, as other investigators ( 31 ) and we have previously reported ( 32 ). Finally, current MR antagonists may not completely block aldosterone effects or concomitant glucocorticoid excess, which can occur in PA ( 13 ).…”

Section: Discussionmentioning

confidence: 57%

Treatment of Primary Aldosteronism and Reversal of Renin Suppression Improves Left Ventricular Systolic Function

et al. 2022

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IntroductionPrimary aldosteronism (PA) is associated with increased risk of cardiovascular events. However, treatment of PA has not been shown to improve left ventricular (LV) systolic function using the conventional assessment with LV ejection fraction (LVEF). We aim to use speckle-tracking echocardiography to assess for improvement in subclinical systolic function after treatment of PA.MethodsWe prospectively recruited 57 patients with PA, who underwent 24-h ambulatory blood pressure (BP) measurements and echocardiography, including global longitudinal strain (GLS) assessment of left ventricle, at baseline and 12 months post-treatment.ResultsAt baseline, GLS was low in 14 of 50 (28.0%) patients. On multivariable analysis, GLS was associated with diastolic BP (P = 0.038) and glomerular filtration rate (P = 0.026). GLS improved post-surgery by −2.3, 95% CI: −3.9 to −0.6, P = 0.010, and post-medications by −1.3, 95% CI: −2.6 to 0.03, P = 0.089, whereas there were no changes in LVEF in either group. Improvement in GLS was independently correlated with baseline GLS (P < 0.001) and increase in plasma renin activity (P = 0.007). Patients with post-treatment plasma renin activity ≥1 ng/ml/h had improvements in GLS (P = 0.0019), whereas patients with persistently suppressed renin had no improvement. Post-adrenalectomy, there were also improvements in LV mass index (P = 0.012), left atrial volume index (P = 0.002), and mitral E/e’ (P = 0.006), whereas it was not statistically significant in patients treated with medications.ConclusionTreatment of hyperaldosteronism is effective in improving subclinical LV systolic dysfunction. Elevation of renin levels after treatment, which reflects adequate reversal of sodium overload state, is associated with better systolic function after treatment.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03174847.

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Section: Discussionmentioning

confidence: 57%

Treatment of Primary Aldosteronism and Reversal of Renin Suppression Improves Left Ventricular Systolic Function

et al. 2022

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“…Evidence indicates that mineralocorticoid receptor antagonists and adrenalectomy achieve similar blood pressure reduction ( 16 ). However, a real word investigation demonstrated that treatment with mineralocorticoid receptor antagonists failed to revert renin suppression in 43% of patients with primary aldosteronism ( 17 ). Failure in renin suppression was associated with enhanced cardiovascular and renal mortality in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Failure in renin suppression was associated with enhanced cardiovascular and renal mortality in these patients. Moreover, 30.7% of treated patients suffered adverse events from spironolactone ( 17 ). A recent study demonstrated that mineralocorticoid receptor antagonists-induced renin suppression was strongly time- and dose-dependent ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Percutaneous adrenal arterial embolization cures resistant hypertension

Zhou

Wang

Liu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPrimary aldosteronism is a common cause of resistant hypertension. Patients with primary aldosteronism due to aldosterone-producing adenoma are generally treated with unilateral adrenalectomy or medical therapy. Superselective adrenal arterial embolization is an alternative treatment for patients with unilateral primary aldosteronism.Case summaryWe present a 39-year-old male patient with a 5-year history of primary aldosteronism and secondary hypertension. The patient refused adrenalectomy while accepted pharmacotherapy. Despite taking adequate dose of spironolactone, the patient experienced repeatedly muscle weakness due to hypokalemia and had poor blood pressure control with left ventricular hypertrophy and renal dysfunction. Aldosterone-producing adenoma in the left adrenal gland was confirmed by computerized tomography and adrenal venous sampling. The left middle adrenal artery, which was confirmed to provide the main arterial supply to the aldosterone-producing adenoma, was embolized by injecting 2 ml ethanol. The embolization normalized his blood pressure for up to 3 months and reversed left ventricular hypertrophy.ConclusionSuperselective adrenal arterial embolization could be an alternative treatment for patients with aldosterone-producing adenoma who refuse adrenalectomy.

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“…The exposure variable of this study was the PRA first measured at least 6 months after the initiation of MRA (post-PRA). Based on the previous studies, 9,10,13,14 posttreatment renin status was defined as unsuppressed (ie, reversal of renin suppression) when post-PRA was ≥1.0 ng/mL per hour and defined as suppressed (ie, remaining of renin suppression) when post-PRA was <1.0 ng/mL per hour. We grouped patients with unsuppressed posttreatment renin into the unsuppressed renin group and those with suppressed posttreatment renin into the suppressed renin group.…”

Section: Exposure Variablementioning

confidence: 99%

“…Some of the important confounders that were not adjusted for in a previous study would include serum potassium and use of beta-blockers, 13 which are associated with both posttreatment renin status and renal function. 14,36,37 To reduce the impact of the confounding by those factors, we adjusted for serum potassium in the main analyses (Table 3) and conducted a sensitivity analysis restricting patients to those who did not use antihypertensive agents that would affect renin status including beta-blockers (Table S3).…”

Section: Original Articlementioning

confidence: 99%

Association of Reversal of Renin Suppression With Long-Term Renal Outcome in Medically Treated Primary Aldosteronism

et al. 2023

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Background: Renin suppression in primary aldosteronism indicates mineralocorticoid receptor activation via excessive aldosterone secretion, inducing renal damage. We investigated whether the reversal of renin suppression after the initiation of mineralocorticoid receptor antagonist therapy was associated with long-term renal outcomes in medically treated patients with primary aldosteronism. Methods: This retrospective cohort study included 318 patients with primary aldosteronism treated with mineralocorticoid receptor antagonist between 2008 and 2020 at the Yokohama Rosai Hospital in Japan. The posttreatment renin status was defined as unsuppressed (ie, reversal of renin suppression) when individual plasma renin activity after the initiation of mineralocorticoid receptor antagonist (post-plasma renin activity) was ≥1.0 ng/(mL h); otherwise, it was defined as suppressed. We analyzed the association of posttreatment renin status with subsequent longitudinal estimated glomerular filtration rate changes using linear mixed-effects models for repeated measurements, adjusting for potential confounders. Results: The posttreatment renin status of 119 patients was unsuppressed (median post-plasma renin activity, 1.7 ng/[mL h]) and that of 199 patients was suppressed (median post-PRA, 0.5 ng/[mL h]). Through the median follow-up period of 3.1 years, the decline in estimated glomerular filtration rate was milder among patients with the unsuppressed posttreatment renin (−0.46 [95% CI, −0.63 to −0.28] mL/min per 1.73 m 2 per year) than those with suppressed posttreatment renin (−1.41 [95% CI, −1.56 to −1.27] mL/min per 1.73 m 2 per year; difference, 0.96 [95% CI, 0.72–1.20] mL/min per 1.73 m 2 per year). Conclusions: Our findings may highlight the importance of reversing renin suppression with optimal mineralocorticoid receptor antagonist titration in medically treated primary aldosteronism, which could mitigate adverse renal outcomes.

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Real-World Effectiveness of Mineralocorticoid Receptor Antagonists in Primary Aldosteronism

Cited by 12 publications

References 51 publications

Treatment of Primary Aldosteronism and Reversal of Renin Suppression Improves Left Ventricular Systolic Function

Treatment of Primary Aldosteronism and Reversal of Renin Suppression Improves Left Ventricular Systolic Function

Case report: Percutaneous adrenal arterial embolization cures resistant hypertension

Association of Reversal of Renin Suppression With Long-Term Renal Outcome in Medically Treated Primary Aldosteronism

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