Subtype identification of surgically curable primary aldosteronism during treatment with mineralocorticoid receptor blockade

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• dc.contributor.author Pintus, Giovanni
• dc.contributor.author Oliveras, Anna
• dc.contributor.author Battistel, Michele
• dc.contributor.author Rossi, Gian Paolo
• dc.date.accessioned 2024-10-21T06:46:28Z
• dc.date.available 2024-10-21T06:46:28Z
• dc.date.issued 2024
• dc.description.abstract Background: Current guidelines and consensus documents recommend withdrawal of mineralocorticoid receptor antagonists (MRAs) before primary aldosteronism (PA) subtyping by adrenal vein sampling (AVS), but this practice can cause severe hypokalemia and uncontrolled high blood pressure. Our aim was to investigate if unilateral PA can be identified by AVS during MRA treatment. Methods: We compared the rate of unilateral PA identification between patients with and without MRA treatment in large data sets of patients submitted to AVS while off renin-angiotensin system blockers and β-blockers. In sensitivity analyses, the between-group differences of lateralization index values after propensity score matching and the rate of unilateral PA identification in subgroups with undetectable (≤2 mUI/L), suppressed (<8.2 mUI/L), and unsuppressed (≥8.2 mUI/L) direct renin concentration levels were also evaluated. Results: Plasma aldosterone concentration, direct renin concentration, and blood pressure values were similar in non-MRA-treated (n=779) and MRA-treated (n=61) patients with PA, but the latter required more antihypertensive agents (P=0.001) and showed a higher rate of adrenal nodules (82% versus 67%; P=0.022) and adrenalectomy (72% versus 54%; P=0.01). However, they exhibited no significant differences in commonly used AVS indices and the area under the receiving operating characteristic curve of lateralization index, both under unstimulated conditions and postcosyntropin. Several sensitivity analyses confirmed these results in propensity score matching adjusted models and in patients with undetectable, or suppressed or unsuppressed renin levels. Conclusions: At doses that controlled blood pressure and potassium levels, MRAs did not preclude the identification of unilateral PA at AVS. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01234220.
• dc.format.mimetype application/pdf
• dc.identifier.citation Pintus G, Seccia TM, Amar L, Azizi M, Riester A, Reincke M, et al. Subtype identification of surgically curable primary aldosteronism during treatment with mineralocorticoid receptor blockade. Hypertension. 2024 Jun;81(6):1391-9. DOI: 10.1161/HYPERTENSIONAHA.124.22721
• dc.identifier.doi http://dx.doi.org/10.1161/HYPERTENSIONAHA.124.22721
• dc.identifier.issn 0194-911X
• dc.identifier.uri http://hdl.handle.net/10230/68267
• dc.language.iso eng
• dc.publisher American Hearth Association
• dc.relation.ispartof Hypertension. 2024 Jun;81(6):1391-9
• dc.rights © 2024 The Authors. Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Aldosterone
• dc.subject.keyword Blood pressure
• dc.subject.keyword Hyperaldosteronism
• dc.subject.keyword Hypertension
• dc.subject.keyword Mineralocorticoid receptor antagonists
• dc.subject.keyword Renin
• dc.title Subtype identification of surgically curable primary aldosteronism during treatment with mineralocorticoid receptor blockade
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion