Primary Aldosteronism Medical Treatment Outcomes (PAMO) Beyond 12 Months.
Primary aldosteronism (PA) is a common and treatable cause of hypertension, yet data on the durability of medical treatment response beyond the first year are limited. Using the PA medical treatment outcomes framework, we evaluated long-term biochemical and clinical outcomes and factors associated with treatment response.
We conducted an international, multicenter, observational cohort study across 27 centers on 4 continents. Adults with PA treated with mineralocorticoid receptor antagonists and epithelial sodium channel blockers between 2016 and 2021 were included if follow-up data were available at ≥12 months. Biochemical and clinical responses were classified as complete, partial, or absent using PA medical treatment outcomes criteria. Ordinal logistic regression identified determinants of a favorable treatment response.
The cohort included 1292 patients (47.5% women, mean age 52 years) with a median follow-up of 34 months (interquartile range, 21-51). At ≥12 months, 58.3% achieved a complete biochemical response, and 20.8% achieved a complete clinical response, with only 5% showing no response. Determinants of a favorable biochemical response included lower aldosterone and lateralization index, and higher renin and potassium levels at baseline. In those taking spironolactone, a higher daily dose was also associated with a favorable biochemical response. Determinants of a favorable clinical response included female sex, lower body mass index, shorter duration of hypertension, and absence of hypertension-mediated organ damage.
Targeted medical therapy for PA can deliver sustained biochemical and clinical benefits. Early disease detection and adequate dose titration are highly actionable determinants of long-term treatment success.
We conducted an international, multicenter, observational cohort study across 27 centers on 4 continents. Adults with PA treated with mineralocorticoid receptor antagonists and epithelial sodium channel blockers between 2016 and 2021 were included if follow-up data were available at ≥12 months. Biochemical and clinical responses were classified as complete, partial, or absent using PA medical treatment outcomes criteria. Ordinal logistic regression identified determinants of a favorable treatment response.
The cohort included 1292 patients (47.5% women, mean age 52 years) with a median follow-up of 34 months (interquartile range, 21-51). At ≥12 months, 58.3% achieved a complete biochemical response, and 20.8% achieved a complete clinical response, with only 5% showing no response. Determinants of a favorable biochemical response included lower aldosterone and lateralization index, and higher renin and potassium levels at baseline. In those taking spironolactone, a higher daily dose was also associated with a favorable biochemical response. Determinants of a favorable clinical response included female sex, lower body mass index, shorter duration of hypertension, and absence of hypertension-mediated organ damage.
Targeted medical therapy for PA can deliver sustained biochemical and clinical benefits. Early disease detection and adequate dose titration are highly actionable determinants of long-term treatment success.
Authors
Yang Yang, Goi Goi, Burrello Burrello, Reincke Reincke, Adolf Adolf, Brűdgam Brűdgam, Li Li, Song Song, Hu Hu, Yang Yang, Satoh Satoh, Ono Ono, Libianto Libianto, Stowasser Stowasser, Li Li, Zhu Zhu, Hong Hong, Nayak Nayak, Puar Puar, Wu Wu, Vaidya Vaidya, Araujo-Castro Araujo-Castro, Kocjan Kocjan, O'Toole O'Toole, Hundemer Hundemer, Ragnarsson Ragnarsson, Lacroix Lacroix, Larose Larose, Nakai Nakai, Nishikawa Nishikawa, Ladygina Ladygina, Turcu Turcu, Vibhatavata Vibhatavata, Fardella Fardella, Uslar Uslar, Quinkler Quinkler, Mulatero Mulatero, Pintus Pintus, Rossi Rossi, Hahner Hahner, Amar Amar, Drake Drake, Varsani Varsani, Brown Brown, Wu Wu, Young Young, Williams Williams, Fuller Fuller
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