SFE/SFHTA/AFCE consensus on primary aldosteronism, part 7: Medical treatment of primary aldosteronism.
Spironolactone, which is a potent mineralocorticoid receptor antagonist, represents the first line medical treatment of primary aldosteronism (PA). As spironolactone is also an antagonist of the androgen and progesterone receptor, it may present side effects, especially in male patients. In case of intolerance to spironolactone, amiloride may be used to control hypokaliemia and we suggest that eplerenone, which is a more selective but less powerful antagonist of the mineralocorticoid receptor, be used in case of intolerance to spironolactone and insufficient control of hypertension by amiloride. Specific calcic inhibitors and thiazide diuretics may be used as second or third line therapy. Medical treatment of bilateral forms of PA seem to be as efficient as surgical treatment of lateralized PA for the control of hypertension and the prevention of cardiovascular and renal morbidities. This allows to propose medical treatment of PA to patients with lateralized forms of PA who refuse surgery or to patients with PA who do not want to be explored by adrenal venous sampling to determine whether they have a bilateral or lateralized form.
Unité d'hypertension, hôpital universitaire de Genève, Genève, Switzerland. Electronic address: Antoinette.Pechere@hcuge.ch.
Antoinette
A
Pechère-Bertschi
Service de cardiologie, centre hospitalier universitaire de Poitiers, 86021 Poitiers, France. Electronic address: Daniel.Herpin@chu-poitiers.fr.
Daniel
D
Herpin
Service d'endocrinologie, diabète et maladies métaboliques, centre hospitalier universitaire, 76031 Rouen, France. Electronic address: herve.lefebvre@chu-rouen.fr.
Hervé
H
Lefebvre
D000077545:Eplerenone; D005260:Female; D005602:France; D006801:Humans; D006929:Hyperaldosteronism / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006973:Hypertension / Q000188:drug therapy; D007008:Hypokalemia / Q000188:drug therapy; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D013148:Spironolactone / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone
Amiloride; Calcic inhibitor; Cardiovascular morbidity; Diurétique thiazidique; Eplerenone; Hyperaldostéronisme primaire; Hypertension; Inhibiteur calcique; Morbidité cardiovasculaire; Primary aldosteronism; Spironolactone; Thiazide diuretic; Éplérenone