Basal Plasma Aldosterone Concentration Predicts Therapeutic Outcomes in Primary Aldosteronism

Aya Saiki; Michio Otsuki; Kosuke Mukai; Reiko Hayashi; Iichiro Shimomura; Isao Kurihara; Takamasa Ichijo; Yoshiyu Takeda; Takuyuki Katabami; Mika Tsuiki; Norio Wada; Yoshihiro Ogawa; Junji Kawashima; Masakatsu Sone; Nobuya Inagaki; Takanobu Yoshimoto; Ryuji Okamoto; Katsutoshi Takahashi; Hiroki Kobayashi; Kouichi Tamura; Kohei Kamemura; Koichi Yamamoto; Shoichiro Izawa; Miki Kakutani; Masanobu Yamada; Akiyo Tanabe; Mitsuhide Naruse


J Endo Soc. 2020;4(4) 

In This Article

Abstract and Introduction


Purpose: Normal basal plasma aldosterone concentration (PAC) reflects mild aldosterone excess compared to high basal PAC. We previously reported lower risk for cardiovascular and cerebrovascular events in patients with primary aldosteronism (PA) and normal basal PAC (nPA) than in those with high basal PAC (hPA). However, the differences in therapeutic outcomes between nPA and hPA are unclear. The aim of this multi-institutional, retrospective cohort study was to determine the clinical significance of nPA to therapeutic outcomes, including adrenalectomy (ADX) and treatment with mineralocorticoid receptor antagonists (MRAs).

Methods: A total of 1146 patients with PA who were diagnosed and underwent adrenal venous sampling (AVS) between January 2006 and October 2016 were enrolled. The clinical parameters at baseline and after ADX or treatment with MRA were compared between the nPA and hPA groups.

Results: Significantly higher rates of absent clinical success (36.6 vs. 21.9%, P = 0.01) and absent biochemical success (26.4 vs. 5.2%, P < 0.01) were found for the nPA group than for the hPA group, respectively. Logistic regression analysis identified baseline PAC as a significant independent predictor of absent clinical success of ADX and MRAs.

Conclusions: Plasma aldosterone concentration at baseline was a significant and independent predictor of absent clinical success of ADX and MRA. Mineralocorticoid receptor antagonist treatment appeared to be a better therapeutic choice than ADX in the nPA group.


Primary aldosteronism (PA) is major cause of secondary hypertension.[1,2] Since autonomous aldosterone hypersecretion induces a rise in blood pressure and direct damage to the myocardium and arterial wall, PA patients are at higher risk of cardiovascular and cerebrovascular (CCV) events than those with essential hypertension.[3–5] This difference in the risk of cardiovascular events is reversed by the management of aldosterone excess by either adrenalectomy (ADX) or treatment with mineralocorticoid receptor antagonists (MRAs).[6] The outcome of treatment suggests that aldosterone excess plays an important role in cardiovascular risk. Previous studies showed that higher plasma aldosterone concentration (PAC),[7,8] hypokalemia,[8,9] unilateral subtype,[8] positive results on the saline infusion test,[10] and positive results on various other confirmatory tests[11] were associated with the risk of CCV events in PA patients. These findings suggest that the hormonal intensity of aldosterone reflects a CCV event risk. A previous study reported that basal PAC was less than 15 ng/dL in 36% of 74 PA patients.[12] We also reported previously that patients with PA and normal basal PAC (<16 ng/dL) (nPA) had clinical features of mild aldosterone excess, such as low incidence of hypokalemia and less use of antihypertensive medications than PA patients with high basal PAC (≥16 ng/dL) (hPA).[7] In addition, nPA was associated with lower risk of CCV events than hPA.[7] However, there is no information on the differences in therapeutic outcomes between nPA and hPA.

The aim of this cross-sectional retrospective study was to determine the clinical significance of nPA in terms of therapeutic outcomes, such as ADX or treatment with MRA.