The key to successful treatment of PA: get it early

Evidence continues to mount regarding the effectiveness of treating primary aldosteronism (PA), with a major international study confirming that early intervention is the best way to beat this hidden cause of hypertension.

A few stark statistics illustrate the scale of the problem:

• Around 1 in 10 people with high blood pressure may have PA.
• That’s around 600,000 people in Australia alone, and 128 million worldwide. 
• Up to 1 in 3 people with resistant hypertension (not improved by medication) may have PA.
• PA creates a higher risk of heart and kidney diseases than the more common forms of hypertension.

The latest study, conducted with 48 international investigators and involving nearly 1300 patients across 27 centres on 4 continents, showed that targeted medical therapy for PA can deliver sustained biochemical and clinical benefits.

It also went further, finding that early detection and correct dosing are excellent determinants of long-term treatment success.

The Primary Aldosteronism Medical Treatment Outcomes (PAMO) beyond 12 months study, published in the journal Hypertension, found that after a median follow-up of around three years post treatment, 82.4% of patients with PA achieved a complete or partial biochemical response, and 84.5% achieved a complete or partial clinical response, with only 5% showing no response in either domain. 

Lead author Professor Jun Yang, senior author Professor Peter Fuller and co-investigator Dr Renata Libianto, from Hudson Institute of Medical Research and Monash Health, said PA is a common and treatable cause of hypertension, but until now data on the durability of medical treatment response beyond the first year was limited.

Studying long-term success of PA treatment

“Using the PA medical treatment outcomes framework, we evaluated long-term biochemical and clinical outcomes and factors associated with treatment response,” Prof Yang said.

“Better outcomes were seen in people diagnosed earlier, before longstanding hypertension and organ damage had developed, highlighting the importance of early detection and adequate treatment of PA.”

“Importantly, better clinical outcomes (that is, achieving normal blood pressure with aldosterone-blocking medication alone) were associated with a shorter duration of hypertension and absence of hypertension-related organ damage at baseline, while adequate spironolactone dosing was associated with better biochemical response (that is, markers showing adequate blockade of aldosterone’s effects, which has been linked to better long term heart health).”

This research builds on the 2025 Lancet Diabetes & Endocrinology PAMO study, which was the first international consensus to establish standardised criteria for assessing clinical and biochemical outcomes of medical treatment for primary aldosteronism.

A significant step in understanding PA treatment

Prof Fuller paid tribute to all the centres for contributing their data, highlighting the value of  international collaboration in advancing global efforts to improve the detection and treatment of  PA.

“This research emphasises the importance of early disease detection as it shows that patients with primary aldosteronism are more likely to have a good long-term response to treatment when they had shorter duration of hypertension, before developing organ damage,” he said.

“Once treatment is started, it is also important to monitor blood markers, particularly renin, alongside blood pressure, to help guide medication dosing and ensure the effects of excess aldosterone are adequately treated.”

“Ultimately, earlier diagnosis and more personalised treatment could improve long-term heart and kidney health for people with primary aldosteronism.”