Endocrine Abstracts

JOINT1653

Introduction: In primary hyperaldosteronism (PH), achieving a plasma renin activity (PRA) ≥ 1 ng/ml/h is associated with a lower cardiovascular risk. This study aims to analyze how many patients achieve this target and evaluate the number (nº) and type of medications used.

Materials and Methods: A retrospective observational study of a cohort of PH patients undergoing medical treatment for: lack of biochemical success after surgery; preference for medical treatment; or being unsuitable for surgery. Based on the PRA value at the last follow-up, patients were divided into two groups (21 patients with PRA <1 and 11 with PRA ≥1). Clinical and analytical data were collected, including the total nº and combinations of antihypertensive drugs used, focusing on the following combinations: mineralocorticoid receptor antagonists (MRAs) with ACE inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), and MRAs with hydrochlorothiazide (HCT), to determine their effectiveness in achieving the PRA target.

Results: During a mean follow-up of 45 months, only 33% of patients achieved the PRA target of ≥1. Clinical and analytical characteristics were similar in both groups, although the number of smokers tended to be higher in the PRA <1 group (P = 0.06). The number of antihypertensive medications (up to 7 drugs) used was similar in both groups (P = 0.61). In the PRA <1 group, the use of eplerenone was higher than that of spironolactone (P = 0.038). No significant differences were found regarding the combination of antihypertensive medications studied and PRA inhibition, although a trend toward significance was observed in patients treated with MRA and HCT (P = 0.068).

Conclusions: Achieving PRA levels ≥1 is difficult with medical treatment, and clinical and analytical characteristics do not help to identify which patients will achieve this target. Eplerenone is the least effective of the MRAs, and the combination of MRA and HCT may be a promising alternative.