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Medically Treated Primary Aldosteronism Outcomes

Lancet Diabetes Endocrinol; ePub 2017 Nov 9; Hundemer, et al

People with primary aldosteronism who received mineralocorticoid receptor (MR) antagonist therapy were more likely to experience cardiometabolic events and death than similarly-treated patients with essential hypertension, according to a study involving >42,000 individuals. Participants had either primary aldosteronism (n=602) or essential hypertension (n=41,853) and were treated with MR antagonists. Investigators looked at incidence of a composite of CV events, as well as several other outcomes. Among the results:

  • Patients with primary aldosteronism experienced ~56 events/1,000 person-years.
  • Those with essential hypertension had 27 events/1,000 person-years.
  • Patients with primary aldosteronism had 34% higher mortality odds.
  • Their risk for diabetes and atrial fibrillation were 26% and nearly 2-fold higher, respectively.
  • Excess risk for CV events and mortality was limited to patients with primary aldosteronism whose renin activity remained suppressed on MR antagonists.
  • Patients treated with higher doses of MR antagonists who had unsuppressed renin were not at significantly higher risk.

Citation:

Hundemer G, Curhan G, Yozamp N, Wang M, Vaidya A, et al. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: A retrospective cohort study. [Published online ahead of print November 9, 2017]. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(17)30367-4.

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