Efficacy and safety of medical treatment of primary aldosteronism: a real-world data study in Spain.
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Goi Jessica, Paja Fano Miguel, Rizo Gellida Alicia, González-Boillos Marga, Rojas-Marcos Patricia Martín, Caja Guayerbas Laura, García Cano Ana María, Ruiz-Sanchez Jorge Gabriel, Vicente Almudena, Gómez-Hoyos Emilia, Recasens Mònica, Barahona San Millan Rebeca, Picón César María José, Díaz Guardiola Patricia, Perdomo Carolina M, Manjón-Miguélez Laura, Rebollo Román Ángel, Robles Lázaro Cristina, Recio José María, Calatayud María, Jiménez López Noemi, Sampedro Nuñez Miguel, Ribas Elena Mena, Sanmartín Sánchez Alicia, Diaz Cesar Gonzalvo, Lamas Cristina, Serrano Joaquín, Michalopoulou Theodora, Rodrigo Susana Tenes, Pascual-Corrales Eider, Aguila Fernando Jaén, Muñoz Rivas Nuria, Moya Mateo Eva María, Gutiérrez-Medina Sonsoles, Hanzu Felicia Alexandra, Parra Ramírez Paola, Araujo-Castro Marta
Аннотация
METHODS: SPAIN-ALDO is a national, multicenter, retrospective registry of patients with PA in Spain. For this study, information about medical treatment with mineralocorticoid receptor antagonist (MRA) as first-line or postsurgical therapy and about antihypertensive medications used before PA targeted treatment (MRA or adrenalectomy) was included. We reported surgically and medically treated patients at baseline and at last available follow-up and evaluated clinical and biochemical responses according to Primary Aldosteronism Surgical Outcome (PASO) and Primary Aldosteronism Medical treatment Outcome (PAMO) criteria.
RESULTS: A total of 997 patients with PA were included. Before PA diagnosis, the classes of antihypertensive drugs most used were calcium-channel blockers (66%) and angiotensin II receptor blockers (48.4%). Of the initial cohort, 880 patients had at least 1 visit available after initiation of MRA (N = 511 as first-line therapy, N = 47 postsurgery) or adrenalectomy (N = 322). The median defined daily dose of MRA therapy was 1.33. Spironolactone was more prescribed than eplerenone (58% vs 42%). Eplerenone was better tolerated than spironolactone (AEs in 4% vs 18%), particularly among males. After a median follow-up of 35 and 17 months for medically and surgically managed patients, the latter achieved a complete biochemical (68.1%) or clinical (33.6%) response more frequently than people under MRA as first-line therapy (48.6% and 15.7%; P < .001).
CONCLUSION: This study underscores the need to optimize PA medical management in Spain to improve patient clinical and biochemical outcomes, since currently the proportion of patients achieving complete clinical and biochemical response with MRA is quite low.