The pharmacological treatment of primary aldosteronism

Abstract

Aldosterone is increasingly considered to have a fundamental role in the pathophysiology of cardiovascular disease. Primary aldosteronism is a much more common cause of secondary hypertension than once suspected, accounting for ∼ 10% of cases. Screening for primary aldosteronism should be considered even in the presence of normokalaemia. The non-classical effects of aldosterone, some of which are transcription-independent, may be of similar or greater importance than its traditional effects on the kidney. Treatment of primary aldosteronism should be specific and aim to ameliorate all hormone-related effects of aldosterone, not just the most obvious manifestation of hypertension. Mineralocorticoid antagonism, shown to lead to significant additional survival advantage in heart failure, offers the best prospect for achieving therapeutic goals. For the increasing proportion of patients with primary aldosteronism suitable for long-term medical treatment, mineralocorticoid receptor blockade (better tolerated with eplerenone) should be considered the most appropriate choice of treatment, pending the development of better alternatives.

Keywords::

• adrenal
• aldosterone
• aldosterone blockade
• amiloride
• eplerenone
• hypertension
• mineralocorticoid receptor antagonist
• potassium canrenoate
• primary aldosteronism
• primary hyperaldosteronism
• spironolactone

Disclaimer

The information contained within the article does not constitute formal prescribing information. Physicians should exercise their own judgement and discretion in diagnosis and treatment in conjunction with formal prescribing information, and assume full responsibility for any decisions reached. The authors disclaim liability from any and all claims arising from use of any information contained within this article.

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