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. 2019 Oct:8:30-39.
doi: 10.1016/j.coemr.2019.07.001. Epub 2019 Jul 9.

The Prevalence of Primary Aldosteronism and Evolving Approaches for Treatment

Nicholas Yozamp  1 , Anand Vaidya  1
Affiliations

The Prevalence of Primary Aldosteronism and Evolving Approaches for Treatment

Nicholas Yozamp et al. Curr Opin Endocr Metab Res. 2019 Oct.

Abstract

Over six decades since primary aldosteronism was first described, much has been learned about its prevalence and optimal treatment. Estimates of the prevalence of primary aldosteronism have increased considerably over the years, even exceeding 20% in some populations of resistant hypertension. Even in patients with normal blood pressures, the prevalence of overt primary aldosteronism and dysregulated aldosterone production may be more common than appreciated. Emerging data support the concept that primary aldosteronism may be better characterized as a continuum of renin-independent aldosterone production, whose severity influences the clinical presentation and risk for incident cardiovascular disease. Mineralocorticoid receptor antagonists and adrenalectomy are the mainstay treatments for primary aldosteronism and have long been considered equally efficacious. However, recent data suggest that while surgical adrenalectomy can effectively reduce cardiovascular risk, mineralocorticoid receptor antagonist therapy may require a physiologic approach to optimize efficacy.

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References

    1. Conn JW. Presidential address. I. Painting background. II. Primary aldosteronism, a new clinical syndrome. J Lab Clin Med. 1955;45(1):3–17. - PubMed
    1. Vaidya A, Mulatero P, Baudrand R, Adler GK. The Expanding Spectrum of Primary Aldosteronism: Implications for Diagnosis, Pathogenesis, and Treatment. Endocr Rev. 2018;39(6):1057–1088. doi: 10.1210/er.2018-00139 - DOI - PMC - PubMed

    1. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic Outcomes and Mortality in Medically Treated Primary Aldosteronism: A Retrospective Cohort Study. Lancet Diabetes Endocrinol. 2018;6(1):51–59. doi: 10.1016/S2213-8587(17)30367-4

      * Annotation: A retrospective cohort study involving 602 patients with primary aldosteronism treated with MR antagonists, 205 patients with primary aldosteronism cured with surgical adrenalectomy, and nearly 42000 patients with essential hypertension who were matched by age and cardiovascular risk profiles. The purpose was to investigate the risk of incident cardiovascular events (myocardial infarction, heart failure hospitalization, and stroke) as well as diabetes, atrial fibrillation, and death between the primary aldosteronism and essential hypertension groups. Despite having comparable blood pressures, the medically-treated patients had substantially higher rates of cardiovascular events, atrial fibrillation, diabetes, and all-cause mortality when compared to patients with essential hypertension. In contrast, patients with surgical cure had a lower risk for developing these outcomes. When the medically-treated patients were further stratified by plasma renin activity, however, only those patients with a suppressed renin activity (<1 ng/ml/h) were at higher risk of adverse outcomes. In contrast, patients treated with a mineralocorticoid receptor antagonist such that their renin substantially rose (>1 ng/mL/h), a biomarker of sufficient volume contraction, had the same risk for incident outcomes as matched patients with essential hypertension. These findings are important in that they implicate renin as a biomarker of treatment efficacy by reflecting adequate mineralocorticoid receptor antagonism/volume contraction.

    1. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Incidence of Atrial Fibrillation and Mineralocorticoid Receptor Activity in Patients With Medically and Surgically Treated Primary Aldosteronism. JAMA Cardiol. 2018;3(8):768–774. doi: 10.1001/jamacardio.2018.2003 - DOI - PMC - PubMed
    1. Hundemer Gregory L, Curhan Gary C, Yozamp Nicholas, Wang Molin, Vaidya Anand. Renal Outcomes in Medically and Surgically Treated Primary Aldosteronism. Hypertension. 2018;72(3):658–666. doi: 10.1161/HYPERTENSIONAHA.118.11568 - DOI - PMC - PubMed

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