Personalized Treatment of Patients With Primary Aldosteronism

Primary aldosteronism (PA) is a highly prevalent yet underdiagnosed secondary cause of hypertension. PA is associated with increased cardiovascular and renal morbidity compared with patients with primary hypertension. Thus, prompt identification and targeted therapy of PA are essential to reduce cardio-vascular and renal morbidity and mortality in a large population with hypertension. Unilateral adre-nalectomy is preferred for lateralized PA as the only potentially curative therapy. Surgery also mitigates the risk of cardiovascular and renal complications associated with PA. Targeted medical therapy, commonly including a mineralocorticoid receptor antagonist, is offered to patients with bilateral PA and those who are not surgical candidates. Novel therapies, including nonsteroidal mineralocorticoid receptor antagonists and aldosterone synthase inhibitors, are being developed as alternative options for PA treatment. In this review article, we discuss how to best individualize therapy for patients with PA.& COPY; 2022 AACE. Published by Elsevier Inc. All rights reserved.

Automated summary

Primary aldosteronism (PA) is a common but underestimated secondary cause of hypertension, associated with increased cardiovascular and renal morbidity compared to primary hypertension. Early identification and targeted therapy are crucial in reducing the morbidity and mortality in a large hypertensive population. Unilateral adrenalectomy is the preferred treatment for lateralized PA, while medical therapy with mineralocorticoid receptor antagonists is offered to bilateral PA patients and those who are not surgical candidates. Novel therapies are being developed as alternative options for PA treatment. This review article discusses the individualized therapy for patients with PA.