| Title: | Subtype identification of surgically curable primary aldosteronism during treatment with mineralocorticoid receptor blockade |
|---|
| Authors: | ID Pintus, Giovanni (Author)
ID Seccia, Teresa Maria (Author)
ID Amar, Laurence (Author)
ID Azizi, Michel (Author)
ID Riester, Anna (Author)
ID Reincke, Martin (Author)
ID Widimský, Jiří (Author)
ID Naruse, Mitsuhide (Author)
ID Kocjan, Tomaž (Author)
ID Negro, Aurelio (Author), et al. |
|---|
| Files: |  PDF - Presentation file, download (553,01 KB)
MD5: 9ABE8FA899B4349A30B810EF2C7EB0F4
 URL - Source URL, visit https://pmc.ncbi.nlm.nih.gov/articles/PMC11095898/pdf/hyp-81-1391.pdf
|
|---|
| Language: | English |
|---|
| Typology: | 1.01 - Original Scientific Article |
|---|
| Organization: |  UKC LJ - Ljubljana University Medical Centre
|
|---|
| 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. |
|---|
| Keywords: | aldosterone, blood pressure, hyperaldosteronism |
|---|
| Publication status: | Published |
|---|
| Publication version: | Version of Record |
|---|
| Year of publishing: | 2024 |
|---|
| Number of pages: | str. 1391-1399 |
|---|
| Numbering: | Vol. 81, iss. 6 |
|---|
| PID: | 20.500.12556/DiRROS-27866  |
|---|
| UDC: | 616.4 |
|---|
| ISSN on article: | 0194-911X |
|---|
| DOI: | 10.1161/HYPERTENSIONAHA.124.22721 |
|---|
| COBISS.SI-ID: | 228506371 |
|---|
| Note: |
|
|---|
| Publication date in DiRROS: | 26.02.2026 |
|---|
| Views: | 95 |
|---|
| Downloads: | 38 |
|---|
| Metadata: |    |
|---|
|
:
|
Copy citation |
|---|
| | | | Share: |  |
|---|
Hover the mouse pointer over a document title to show the abstract or click
on the title to get all document metadata. |
