Primary Aldosteronism and the Role of Mineralocorticoid Receptor Antagonists for the Heart and Kidneys

Primary aldosteronism (PA) is the most common cause of secondary hypertension but is frequently underrecognized and undertreated. Patients with PA are at a markedly increased risk for target organ damage to the heart and kidneys. While patients with unilateral PA can be treated surgically, many patients with PA are not eligible or willing to undergo surgery. Steroidal mineralocorticoid receptor antagonists (MRAs) are highly effective for treating PA and reducing the risk of target organ damage. However, steroidal MRAs are often underprescribed and can be poorly tolerated by some patients due to side effects. Nonsteroidal MRAs reduce adverse renal and cardiovascular outcomes among patients with diabetic kidney disease and are better tolerated than steroidal MRAs. While their blood pressure-lowering effects remain unclear, these agents may have a potential role in reducing target organ damage in patients with PA.

Automated summary

Primary aldosteronism (PA) is frequently overlooked and undertreated, despite being the most common cause of secondary hypertension. PA patients are at high risk for heart and kidney damage. While surgical treatment is an option for unilateral PA, many patients are not suitable or do not want surgery. Steroidal mineralocorticoid receptor antagonists (MRAs) effectively treat PA but are often underprescribed due to side effects. Nonsteroidal MRAs, on the other hand, reduce adverse renal and cardiovascular outcomes and are better tolerated. Their potential role in reducing target organ damage in PA patients, however, is still uncertain.