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The following is a summary of “Outcomes after medical treatment for primary aldosteronism: an international consensus and analysis of treatment response in an international cohort,” published in the January 2025 issue of Endocrinology by Yang et al. 

Researchers conducted a retrospective study to develop criteria for evaluating treatment outcomes in primary aldosteronism, analyze outcomes across an international cohort, and identify factors associated with a complete treatment response.  

They engaged an international panel of 31 primary aldosteronism experts to use the Delphi method for defining complete, partial, or absent biochemical and clinical outcomes of medical treatment for primary aldosteronism. Clinical data were collected at baseline and 6-12 months post-treatment from patients who began targeted medical treatment between 2016 and 2021 at 28 participating centres.  

The results showed the consensus was achieved on defining complete, partial, or absent biochemical and clinical responses. Out of 1,258 patients (mean age 52 years [SD 11.5], 610 [48.5%] female, 648 [51.5%] male), 1,057 (84.0%) had biochemical outcome data, with 559 (52.9%) showing a complete biochemical response. The median daily dose of spironolactone was higher for those with a complete biochemical response (40 mg [IQR 25–50]) compared to those without (25 mg [20–50], p=0.011). Among 1248 patients with clinical outcome data, 228 (18.3%) had a complete clinical response, and 227 (18.2%) showed an absent response. Women were more likely to have a complete clinical response (OR 2.099, 95% CI 1.485–2.968, P <0.001) and required lower baseline antihypertensive doses (OR 0.687, 95% CI 0.603–0.782, P <0.001). They were also less likely to have microalbuminuria or left ventricular hypertrophy (OR 0.584, 95% CI 0.391–0.873, P =0.009).  

Investigators concluded the e Primary Aldosteronism Medical Treatment Outcome (PAMO) criteria provide an internationally recognized standard for evaluating outcomes in primary aldosteronism, guiding clinical practice and research while emphasizing the need for optimizing treatment intensity and addressing factors that hinder treatment response to improve patient outcomes. 

Source: thelancet.com/journals/landia/article/PIIS2213-8587(24)00308-5/abstract