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

  • Tang, Fengjie1
  • Loh, Lih M2
  • Foo, Roger S3, 4
  • Loh, Wann J5
  • Lim, Dawn S T2
  • Zhang, Meifen5
  • Tan, Pei T6
  • Swee, Du S2
  • Khoo, Joan5
  • Tay, Donovan7
  • Lee, Lynette2, 5
  • Tan, Sarah Y2, 5
  • Zhu, Ling2
  • Soh, Shui B5
  • Tan, Eberta5
  • Kek, Peng C2
  • Puar, Troy H5
  • 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077 , (Singapore)
  • 2 Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608 , (Singapore)
  • 3 Cardiovascular Research Institute, Centre for Translational Medicine, MD6, National University Health System, Singapore 117599 , (Singapore)
  • 4 Genome Institute of Singapore, Singapore 138672 , (Singapore)
  • 5 Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889 , (Singapore)
  • 6 Department of Clinical Trial Research Unit, Changi General Hospital, SingHealth, Singapore 529889 , (Singapore)
  • 7 Department of Endocrinology, Sengkang General Hospital, SingHealth, Singapore 544886 , (Singapore)
Published Article
Journal of the Endocrine Society
The Endocrine Society
Publication Date
Aug 31, 2021
DOI: 10.1210/jendso/bvab144
PMID: 34541440
PMCID: PMC8442943
PubMed Central
  • AcademicSubjects/MED00250


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.

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