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16-01-2024 | Adrenalectomy | Original article

Renin as a Biomarker to Guide Medical Treatment in Primary Aldosteronism Patients. Findings from the SPAIN-ALDO Registry

Authors: Paola Parra Ramírez, Patricia Martín Rojas-Marcos, Miguel Paja Fano, Margarita González-Boillos, Eider Pascual-Corrales, Ana María García Cano, Jorge Gabriel Ruiz-Sanchez, Almudena Vicente Delgado, Emilia Gómez Hoyos, Rui Ferreira, Iñigo García Sanz, Mònica Recasens Sala, Rebeca Barahona San Millan, María José Picón César, Patricia Díaz Guardiola, Carolina M. Perdomo, Laura Manjón-Miguélez, Ángel Rebollo Román, Cristina Robles Lázaro, Manuel Morales-Ruiz, María Calatayud, Simone Andree Furio Collao, Diego Meneses, Miguel Antonio Sampedro-Nuñez, Elena Mena Ribas, Alicia Sanmartín Sánchez, Cesar Gonzalvo Diaz, Cristina Lamas, Raquel Guerrero-Vázquez, María del Castillo Tous, Joaquín Serrano Gotarredona, Theodora Michalopoulou Alevras, Susana Tenés Rodrigo, Ricardo Roa Chamorro, Fernando Jaen Aguila, Eva María Moya Mateo, Felicia A. Hanzu, Marta Araujo-Castro

Published in: High Blood Pressure & Cardiovascular Prevention | Issue 1/2024

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Abstract

Introduction

Primary aldosteronism (PA) is associated with several cardiometabolic comorbidities. Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy has been reported to reduce the cardiometabolic risk. However, the cardiovascular benefit could depend on plasma renin levels in patients on MRA.

Aim

To compare the development of cardiovascular, renal and metabolic complications between medically treated patients with PA and those who underwent adrenalectomy, taking the renin status during MRA treatment into account.

Methods

A multicenter retrospective study (SPAIN-ALDO Register) of patients with PA treated at 35 Spanish tertiary hospitals. Patients on MRA were divided into two groups based on renin suppression (n = 90) or non-suppression (n = 70). Both groups were also compared to unilateral PA patients (n = 275) who achieved biochemical cure with adrenalectomy.

Results

Adrenalectomized patients were younger, had higher plasma aldosterone concentration, and lower potassium levels than MRA group. Patients on MRA had similar baseline characteristics when stratified into treatment groups with suppressed and unsuppressed renin. 97 (55.1%) of 176 patients without comorbidities at diagnosis, developed at least one comorbidity during follow-up (median 12 months vs. 12.5 months’ follow-up after starting MRA and surgery, respectively). Surgery group had a lower risk of developing new cardiovascular events (HR 0.40 [95% CI 0.18–0.90]) than MRA group. Surgical treatment improved glycemic and blood pressure control, increased serum potassium levels, and required fewer antihypertensive drugs than medical treatment. However, there were no differences in the cardiometabolic profile or the incidence of new comorbidities between the groups with suppressed and unsuppressed renin levels (HR 0.95 [95% CI 0.52–1.73]).

Conclusion

Cardiovascular, renal, and metabolic events were comparable in MRA patients with unsuppressed and suppressed renin. Effective surgical treatment of PA was associated with a decreased incidence of new cardiovascular events when compared to MRA therapy.
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Metadata
Title
Renin as a Biomarker to Guide Medical Treatment in Primary Aldosteronism Patients. Findings from the SPAIN-ALDO Registry
Authors
Paola Parra Ramírez
Patricia Martín Rojas-Marcos
Miguel Paja Fano
Margarita González-Boillos
Eider Pascual-Corrales
Ana María García Cano
Jorge Gabriel Ruiz-Sanchez
Almudena Vicente Delgado
Emilia Gómez Hoyos
Rui Ferreira
Iñigo García Sanz
Mònica Recasens Sala
Rebeca Barahona San Millan
María José Picón César
Patricia Díaz Guardiola
Carolina M. Perdomo
Laura Manjón-Miguélez
Ángel Rebollo Román
Cristina Robles Lázaro
Manuel Morales-Ruiz
María Calatayud
Simone Andree Furio Collao
Diego Meneses
Miguel Antonio Sampedro-Nuñez
Elena Mena Ribas
Alicia Sanmartín Sánchez
Cesar Gonzalvo Diaz
Cristina Lamas
Raquel Guerrero-Vázquez
María del Castillo Tous
Joaquín Serrano Gotarredona
Theodora Michalopoulou Alevras
Susana Tenés Rodrigo
Ricardo Roa Chamorro
Fernando Jaen Aguila
Eva María Moya Mateo
Felicia A. Hanzu
Marta Araujo-Castro
Publication date
16-01-2024
Publisher
Springer International Publishing
Published in
High Blood Pressure & Cardiovascular Prevention / Issue 1/2024
Print ISSN: 1120-9879
Electronic ISSN: 1179-1985
DOI
https://doi.org/10.1007/s40292-023-00618-w

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