Primary Aldosteronism Medical Treatment Outcomes (PAMO) Beyond 12 Months

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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Journal
Hypertension
Published
2026-07-22
DOI
https://doi.org/10.1161/hypertensionaha.126.27431
Primary Topic
Hormonal Regulation and Hypertension
Type
article
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article

Primary Aldosteronism Medical Treatment Outcomes (PAMO) Beyond 12 Months

D. O. Ladygina, Thomas Uslar, Christian Adolf, André Lacroix et al.
Hypertension
Hormonal Regulation and Hypertension
article

Primary Aldosteronism Medical Treatment Outcomes (PAMO) Beyond 12 Months

D. O. Ladygina, Thomas Uslar, Christian Adolf, André Lacroix, Yoshikiyo Ono, Samuel O’Toole, Martín Reincke, Fumitoshi Satoh, Michael Stowasser, Paolo Mulatero, Jacopo Burrello, Kazuki Nakai, Vin‐Cent Wu, Óskar Ragnarsson, Troy Hai Kiat Puar, Giovanni Pintus, Tracy Ann Williams, Jinbo Hu, Qing Zhu, Stefanie Hahner, Carlos Fardella, Namki Hong, Adina F. Turcu, Denise Brüdgam, Peter J. Fuller, Marta Araujo‐Castro, Jun Yang, Tomaž Kocjan, William F. Young, Tetsuo Nishikawa, Gregory L. Hundemer, Renata Libianto, Stéphanie Larose, Anand Vaidya, Nanfang Li, Gian Paolo Rossi, Xilin Wu, Laurence Amar, Marcus Quinkler, Peeradon Vibhatavata, Chetna Varsani, Shumin Yang, Ying Song, Qifu Li, Morris J. Brown, Jessica Goi, William M. Drake, Drishya Nayak
article en

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Hypertension
Brigham and Women's Hospital (US), St Bartholomew's Hospital (GB), Mayo Clinic (US), University of Padua (IT), University of Ottawa (CA), University of Ljubljana (SI), SingHealth (SG), Pontificia Universidad Católica de Chile (CL), Queen Mary University of London (GB), Sechenov University (RU), Yonsei University (KR), Tohoku University (JP), Instituto Cajal (ES), Diabetes Australia (AU), Ljubljana University Medical Centre (SI), Royal Hallamshire Hospital (GB), Princess Alexandra Hospital (AU), Changi General Hospital (SG), Hudson Institute of Medical Research (AU), LMU Klinikum (DE), Tohoku University Hospital (JP), Hospital Clínico de la Universidad Católica (CL), Monash Health (AU), People's Hospital of Xinjiang Uygur Autonomous Region (CN), Wallenberg Wood Science Center (SE), Mayo Clinic in Arizona (US), Universitätsklinikum Würzburg (DE), Department of Medical Sciences (BY), The Affiliated Yongchuan Hospital of Chongqing Medical University (CN), National Taiwan University Hospital (TW), Yokohama Rosai Hospital (JP), Unit of Functional and Adaptive Biology (FR), Centre Hospitalier de l’Université de Montréal (CA), Queen Mary's Hospital (GB), Mayo Clinic in Florida (US), Hospital Universitario Ramón y Cajal (ES), Monash University (AU), Ludwig-Maximilians-Universität München (DE), Chongqing Medical University (CN)
Good health and well-being
Openalex Percentile: Top 8%
Hormonal Regulation and Hypertension
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