Tolerability and Efficacy of Long-Term Medical Therapy in Primary Aldosteronism.

Autor:	Tang F; Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore., Loh LM; Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore., Foo RS; Cardiovascular Research Institute, Centre for Translational Medicine, MD6, National University Health System, Singapore 117599, Singapore.; Genome Institute of Singapore, Singapore 138672, Singapore., Loh WJ; Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore., Lim DST; Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore., Zhang M; Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore., Tan PT; Department of Clinical Trial Research Unit, Changi General Hospital, SingHealth, Singapore 529889, Singapore., Swee DS; Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore., Khoo J; Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore., Tay D; Department of Endocrinology, Sengkang General Hospital, SingHealth, Singapore 544886, Singapore., Lee L; Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore.; Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore., Tan SY; Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore.; Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore., Zhu L; Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore., Soh SB; Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore., Tan E; Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore., Kek PC; Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore., Puar TH; Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore.
Jazyk:	angličtina
Zdroj:	Journal of the Endocrine Society [J Endocr Soc] 2021 Aug 31; Vol. 5 (11), pp. bvab144. Date of Electronic Publication: 2021 Aug 31 (Print Publication: 2021).
DOI:	10.1210/jendso/bvab144
Abstrakt:	Introduction: Patients with primary aldosteronism (PA) have increased cardiovascular risk, and there are concerns about the efficacy of medical therapy. Objective: We aimed to assess long-term tolerability and efficacy of medical therapy in PA patients. Methods: We conducted a retrospective study on 201 PA patients treated with medical therapy (spironolactone, eplerenone, or amiloride) from 2000 to 2020 at 2 tertiary centers. Clinical and biochemical control and side effects were assessed. Results: Among 155 patients on long-term medications, 57.4% achieved blood pressure (BP) <140/90 mmHg, 90.1% achieved normokalemia (48.0% potassium ≥4.3 mmol/L), and 63.2% achieved renin >1 ng/mL/h. Concordance of biochemical control using potassium and renin levels was 49.1%. Side effects were experienced by 52.3% of patients, with 10.3% switching, 22.6% decreasing dose, and 11.0% stopping medications. Risk factors for side effects were spironolactone use, dose ≥ 50 mg, treatment duration ≥1 year, male gender, and unilateral PA. Patients with unilateral PA used higher spironolactone doses vs bilateral (57 vs 50 mg, P < 0.001) and had more side effects (63.2% vs 41.8%, P = 0.008). Forty-six unilateral PA patients who underwent surgery after initial medical therapy experienced improved BP (systolic from 141 to 135 mmHg, P = 0.045; diastolic from 85 to 79 mmHg, P = 0.002). Conclusion: Dose-dependent side effects limit efficacy of medical therapy in PA. Future prospective studies should assess the best monitoring strategy for biochemical control during long-term medical therapy. For unilateral PA, surgery remains preferable, yielding better control with less long-term side effects. (© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu