Tolerability and efficacy of long-term medical therapy in primary aldosteronism

Introduction: Patients with primary aldosteronism (PA) have increased cardiovascular risk and studies have found that medical therapy fails to ameliorate this. This may be due to side effects and limited efficacy of medications at tolerable doses.

Methods: We conducted a retrospective study on 201 patients with PA treated with medical therapy (spironolactone, eplerenone or amiloride) for PA from 2000-2020 at two tertiary centres. Patients were assessed for efficacy to achieve clinical and biochemical control, and for side effects.

Results: 53.7% of patients achieved blood pressure <140/90mmHg, 44.6% achieved potassium ≥4.3mmol/L, 63.2% achieved renin >1ng/ml/hr, and only 24.6% achieved all three. Concordance of biochemical control using potassium and renin levels was 49%. 45.3% of patients experienced side effects, with 8.5% switching to another medication, 18.9% decreasing dose, and 10.0% stopping medications altogether. Risk factors for side effects were spironolactone use...