Primary Aldosteronism and the Role of Mineralocorticoid Receptor Antagonists for the Heart and Kidneys

• Published in: Annual review of medicine 2023-01, Vol.74 (1), p.217-230
• Main Authors: Cohen, Jordana B, Bancos, Irina, Brown, Jenifer M, Sarathy, Harini, Turcu, Adina F, Cohen, Debbie L
• Format: Article
• Language: English
• Subjects: Blood Pressure; cardiovascular disease; chronic kidney disease; Diabetes mellitus; Endocrine disorders; Humans; Hyperaldosteronism - drug therapy; Hyperaldosteronism - surgery; hypertension; Hypertension - drug therapy; Kidney; Kidney diseases; mineralocorticoid receptor antagonists; Mineralocorticoid Receptor Antagonists - therapeutic use; Patients; primary aldosteronism
• ISSN: 0066-4219; 1545-326X; 1545-326X
• DOI: 10.1146/annurev-med-042921-100438

Primary aldosteronism (PA) is the most common cause of secondary hypertension but is frequently underrecognized and undertreated. Patients with PA are at a markedly increased risk for target organ damage to the heart and kidneys. While patients with unilateral PA can be treated surgically, many patients with PA are not eligible or willing to undergo surgery. Steroidal mineralocorticoid receptor antagonists (MRAs) are highly effective for treating PA and reducing the risk of target organ damage. However, steroidal MRAs are often underprescribed and can be poorly tolerated by some patients due to side effects. Nonsteroidal MRAs reduce adverse renal and cardiovascular outcomes among patients with diabetic kidney disease and are bettertolerated than steroidal MRAs. While their blood pressure-lowering effects remain unclear, these agents may have a potential role in reducing target organ damage in patients with PA.