Subtype Identification of Surgically Curable Primary Aldosteronism During Treatment With Mineralocorticoid Receptor Blockade.
Journal
Hypertension (Dallas, Tex. : 1979)
Journal Volume
81
Journal Issue
6
Start Page
1391
End Page
1399
ISSN
1524-4563
Date Issued
2024-06
Author(s)
Pintus, Giovanni
Seccia, Teresa Maria
Amar, Laurence
Azizi, Michel
Riester, Anna
Reincke, Martin
Widimský, Jiří
Naruse, Mitsuhide
Kocjan, Tomaz
Negro, Aurelio
Kline, Gregory
Tanabe, Akiyo
Satoh, Fumitoshi
Rump, Lars Christian
Vonend, Oliver
Fuller, Peter J
Yang, Jun
Chee, Nicholas Yong Nian
Magill, Steven B
Shafigullina, Zulfiya
Quinkler, Marcus
Oliveras, Anna
Krátká, Zuzana
Battistel, Michele
Bagordo, Domenico
Caroccia, Brasilina
Ceolotto, Giulio
Rossitto, Giacomo
Rossi, Gian Paolo
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.
Subjects
aldosterone
blood pressure
hyperaldosteronism
hypertension
mineralocorticoid receptor antagonists
renin
Type
journal article