Long Term Renal Outcomes In Patients With Primary Aldosteronism

Document Type

Conference Proceeding

Publication Date

10-22-2025

Publication Title

J Endocr Soc

Keywords

aldosterone, antihypertensive agent, mineralocorticoid antagonist, potassium, adrenalectomy, adult, aged, antihypertensive therapy, blood pressure, Caucasian, chronic kidney failure, cohort analysis, complication, conference abstract, controlled study, creatinine blood level, diastolic blood pressure, drug therapy, estimated glomerular filtration rate, female, human, hyperaldosteronism, hypertension, hypotension, kidney function, major clinical study, male, potassium blood level, primary hyperaldosteronism, race difference, retrospective study, special situation for pharmacovigilance, suprarenal vein, systolic blood pressure, tertiary care center

Abstract

Background: Primary aldosteronism (PA) is a condition of excessive aldosterone, leading to hypertension and increased risk of cardiovascular and kidney complications. Effective therapy reverses complications, normalizes potassium levels, controls blood pressure, and potentially reduces pill burden. Objective: To determine racial differences in renal outcomes of PA patients who underwent medical or surgical intervention Design: Retrospective study of PA patients who underwent adrenal vein sampling (AVS) over a 12-year period Setting: Academic tertiary care setting Main outcomes measured: Blood pressure (BP), serum potassium, serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) pre and post treatment for PA, and number of anti-hypertensive medications Results: 113 patients with PA who underwent AVS with a median age of 58 years [36 White (32%), 77 Black (68%)] were included. No significant differences in age or BMI between races. 48 patients underwent adrenalectomy (Black n=30, 63% and White n=18, 37%) and 65 patients were treated medically with mineralocorticoid antagonists (MRA) (Black n=47, 72% and White n=18, 28%). Baseline findings: (i) White patients had higher mean systolic BP (Black 149 vs White 155 mmHg, p = 0.03), (ii) Black patients had higher mean serum creatinine (Black 1.1 vs White 0.91 mg/dL, p = 0.05), and lower potassium compared to White patients (Black 2.9 vs White 3.1 mEq, p = 0.047). No significant differences in diastolic BP, number of BP medications, and mean total daily dose of MRA between races. Overall, patients had significant improvement in both systolic and diastolic BP following intervention (medical, surgical, or both). Mean systolic BP decreased (pre 151 vs post 129 mmHg, p < 0.0001), and mean diastolic BP decreased (pre 90 vs post 80 mmHg, p < 0.0001) with treatment. However, serum creatinine level increased (pre 1.0 vs post 1.6 mg/dL, p < 0.0001) and mean eGFR declined (pre 83 vs post 65 mL/min/1.73 m2, p < 0.0001) after treatment. Patients who underwent adrenalectomy had higher mean serum potassium (surgical 3.9 vs medical 3.5 mEq, p<0.0001), required fewer average number of BP medications (surgical 1.7 vs medical 2.5, p = 0.0006), and had lower BP compared to those managed medically, although not statistically significant. At the end of the study period, there was no significant difference between serum potassium or systolic and diastolic BP between Black and White patients. Black patients required more antihypertensives for BP control. Conclusion: Patients with PA who undergo adrenalectomy require fewer antihypertensives and have higher serum potassium than those managed medically. While treatment improves blood pressure and potassium levels, renal function continues to decline, underscoring the need for early diagnosis and timely intervention to prevent chronic kidney disease. .

Volume

9

First Page

A415

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