Annual Review of Medicine Primary Aldosteronism and the Role of Mineralocorticoid Receptor Antagonists for the Heart and Kidneys Jordana B. Cohen, 1,2 Irina Bancos, 3 Jenifer M. Brown, 4 Harini Sarathy, 5 Adina F. Turcu, 6 and Debbie L. Cohen 1 1 Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; email: [email protected], [email protected] 2 Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA 3 Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA; email: [email protected] 4 Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA; email: [email protected] 5 Division of Nephrology, Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA; email: [email protected] 6 Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA; email: [email protected] Annu. Rev. Med. 2023. 74:217–30 First published as a Review in Advance on November 14, 2022 The Annual Review of Medicine is online at med.annualreviews.org https://doi.org/10.1146/annurev-med-042921- 100438 Copyright © 2023 by the author(s). This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See credit lines of images or other third-party material in this article for license information. Keywords primary aldosteronism, mineralocorticoid receptor antagonists, hypertension, cardiovascular disease, chronic kidney disease Abstract Primary aldosteronism (PA) is the most common cause of secondary hyper- tension but is frequently underrecognized and undertreated. Patients with PA are at a markedly increased risk for target organ damage to the heart and kidneys. While patients with unilateral PA can be treated surgically, many pa- tients with PA are not eligible or willing to undergo surgery. Steroidal min- eralocorticoid receptor antagonists (MRAs) are highly effective for treating PA and reducing the risk of target organ damage. However, steroidal MRAs are often underprescribed and can be poorly tolerated by some patients due to side effects. Nonsteroidal MRAs reduce adverse renal and cardiovascular outcomes among patients with diabetic kidney disease and are better 217 Annu. Rev. Med. 2023.74:217-230. Downloaded from www.annualreviews.org Access provided by 117.3.252.4 on 04/20/23. See copyright for approved use.
Primary Aldosteronism and the Role of Mineralocorticoid Receptor Antagonists for the Heart and Kidneys
Apr 20, 2023
Primary aldosteronism (PA) is the most common cause of secondary hypertension but is frequently underrecognized and undertreated. Patients with
PA are at a markedly increased risk for target organ damage to the heart and
kidneys.While patients with unilateral PA can be treated surgically,many patients with PA are not eligible or willing to undergo surgery. Steroidal mineralocorticoid receptor antagonists (MRAs) are highly effective for treating
PA and reducing the risk of target organ damage
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However, steroidal MRAs are often underprescribed and can be poorly tolerated by some patients due to side effects. Nonsteroidal MRAs reduce adverse renal and cardiovascular outcomes among patients with diabetic kidney disease and are better tolerated than steroidal MRAs. While their blood pressure–lowering effects remain unclear, these agents may have a potential role in reducing target organ damage in patients with PA.
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