Are We Aiming for Cure or Lifelong Treatment of Hypertension? All Doctors Need To Be Aware of Primary Aldosteronism. A Nationwide Study With Up To 8-Year Follow-Up

Purpose Long term follow-up studies on primary aldosteronism (PA) diagnosis, treatment response and comparison of the two major subgroups – unilateral (UD) and bilateral disease (BD) – are lacking. While adrenalectomy for UD is considered effective, less is known about long-term effects of specialized treatment for BD. We present the results from our nationwide observational study, executed at Landspitali University Hospital, tertiary referral center. We aim to review results of diagnostic procedures and histopathology for PA patients diagnosed in 2012-2016 in Iceland, compare UD and BD and assess treatment response. Methods A total of 32 PA patients aged 28-88 years were diagnosed and treated according to current guidelines. Adrenalectomy was used for AVS-confirmed UD and mineralocorticoid receptor antagonists for BD. Results The majority of patients had BD, roughly half of them had a unilateral nodule. With specialized treatment, a reduction was seen in UD and BD in systolic blood pressure (BP) (p<0,001, both groups), antihypertensive drug count (p=0,002 and p=0,04, respectively) and need for potassium supplementation (p<0,001, both groups). Diastolic BP decreased significantly in UD (p<0,001). Conclusion Our results show similarly good treatment response in both subgroups. Ratio of hypokalemia and number of cases indicates severe PA underdiagnosis in Iceland. Adrenal nodules diagnosed using CT can be misleading and AVS is mandatory in diagnosing unilateral vs bilateral PA.