Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

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.


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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