Personalized Treatment of Patients With Primary Aldosteronism

• Published in: Endocrine practice Vol. 29; no. 6; p. 484
• Main Authors: Obeid, Hiba, Chen Cardenas, Stanley M, Khairi, Shafaq, Turcu, Adina F
• Format: Journal Article
• Language: English
• Published: United States 01.06.2023
• Subjects: Adrenalectomy - adverse effects; Aldosterone; Humans; Hyperaldosteronism - therapy; Hypertension - etiology; Hypertension - therapy; Mineralocorticoid Receptor Antagonists - therapeutic use; Precision Medicine - adverse effects; mineralocorticoid receptor antagonist; hypertension; adrenal venous sampling; aldosterone; renin; primary aldosteronism
• ISSN: 1530-891X
• DOI: 10.1016/j.eprac.2022.10.008

Primary aldosteronism (PA) is a highly prevalent yet underdiagnosed secondary cause of hypertension. PA is associated with increased cardiovascular and renal morbidity compared with patients with primary hypertension. Thus, prompt identification and targeted therapy of PA are essential to reduce cardiovascular and renal morbidity and mortality in a large population with hypertension. Unilateral adrenalectomy is preferred for lateralized PA as the only potentially curative therapy. Surgery also mitigates the risk of cardiovascular and renal complications associated with PA. Targeted medical therapy, commonly including a mineralocorticoid receptor antagonist, is offered to patients with bilateral PA and those who are not surgical candidates. Novel therapies, including nonsteroidal mineralocorticoid receptor antagonists and aldosterone synthase inhibitors, are being developed as alternative options for PA treatment. In this review article, we discuss how to best individualize therapy for patients with PA.