Endocrine Abstracts

Introduction: Primary aldosteronism (PA) accounts for 5-10% of patients with hypertension. Approximately 40-50% of cases are bilateral, usually managed using mineralocorticoid receptor antagonists (MRAs). Recent literature suggests a higher risk of renovascular disease and cardiovascular events in PA patients treated medically, compared to those with essential hypertension. This excess risk is mitigated in individuals with unilateral disease managed surgically with adrenalectomy, and in patients on MRA therapy where renin de-suppression (>1 mg/l per h) is achieved (1,2). These findings suggest titration of MRA therapy to raise renin should be adopted into clinical practice.

Aims and Methods: To identify those patients with PA in whom a decision was made for medical therapy, and to establish how many have had an attempt to titrate MRA therapy against renin. We report outcomes in consecutive patients under the care of a clinician with an academic interest in PA at a single Endocrinology centre between January 2019 to June 2023. Patients participating in other clinical research studies were excluded.

Results: 20/43 (47%) patients with PA managed medically had renin monitoring during follow-up. In 16/20 patients, monitoring of renin resulted in an improvement in their renin levels, which required multiple dose changes in 10 individuals. Renin remained suppressed in 4/20 patients despite attempts to uptitrate MRAs.

Conclusion: Renin monitoring was not conducted in more than half the study population. The most likely reason is lack of awareness of the importance of renin de-suppression in improving long-term cardio and renovascular outcomes. Other factors such as the COVID-19 pandemic and patients’ reluctance to attend for face-to-face follow-up appointments may have also contributed to this shortfall. Our intention is to disseminate these findings and recommendations to our peers using this platform, to ensure patients receive evidence based clinical care.

References: PMID: 29987110, 29129576