New Primary Aldosteronism treatment target identified

Identifying a disease is one thing, establishing the best treatment option is another entirely, and in the case of Primary Aldosteronism (PA) the team at Hudson Institute of Medical Research is well on the way to both.

Associate Professor Jun Yang and her team in Hudson’s Primary Aldosteronism Centre of Research Excellence (PACE) have been global leaders in establishing the prevalence and impact of PA.

Now they have completed a review of 24 studies involving over 6,600 patients worldwide, to bring together global evidence linking post-treatment renin status with cardiovascular, renal, and mortality outcomes in medically treated PA.

Primary Aldosteronism treatment reduces cardiovascular & death risk

Their findings have recently been published in The Lancet Diabetes & Endocrinology.

This study, led by Dr Sho Katsuragawa, is the first to comprehensively synthesise evidence on the association between post-treatment renin levels and a wide range of clinical outcomes among patients with PA. 

His work identified that patients with PA whose renin levels became unsuppressed (normalised) after initiation of mineralocorticoid receptor antagonist (MRA) had a significantly lower risk of cardiovascular events and death compared with those whose renin remained suppressed.

Dr Katsuragawa said that most patients with PA require lifelong medication with MRA rather than surgery, yet there has been uncertainty about optimised medical treatment strategy.

Targeting renin to evaluate treatment

“Many clinicians, while focusing on blood pressure control in the medical treatment of PA, pay little attention to post-treatment renin levels,” he said. “This research shows that targeting renin could help clinicians evaluate whether medical therapy is working optimally, potentially reducing cardiovascular complications and improving patient outcomes over time.”

“This finding suggests that post-treatment renin normalisation could be an important medical treatment goal, reflecting adequate mineralocorticoid receptor blockade.”

“It supports current expert recommendations that renin normalisation should be achieved by up-titrating MRA in medical management for PA, especially in a cardiovascular protection perspective.”

Dr Katsuragawa believes that better management of this condition could therefore have major public health benefits by reducing cardiovascular and renal morbidity in a large patient population.

What is Primary Aldosteronism?

• PA (also known as Conn Syndrome) is a common but under-recognised cause of high blood pressure
• One in 10 patients with hypertension has PA but it is often misdiagnosed as conventional hypertension
• Less than one in 100 patients is diagnosed correctly
• PA leads to greater risk of heart and kidney disease
• PA increases the risk of cardiovascular disease, renal disease, and death, compared with non-PA hypertension, if inadequately treated