BACKGROUND: Current guidelines and consensus documents recommend withdrawal of mineralocorticoid receptor antagonists (MRAs) before primary aldosteronism (PA) subtyping by adrenal vein sampling (AVS), but this practice can cause severe hypokalemia and uncontrolled high blood pressure. Our aim was to investigate if unilateral PA can be identified by AVS during MRA treatment. METHODS: We compared the rate of unilateral PA identification between patients with and without MRA treatment in large data sets of patients submitted to AVS while off renin-angiotensin system blockers and β-blockers. In sensitivity analyses, the between-group differences of lateralization index values after propensity score matching and the rate of unilateral PA identification in subgroups with undetectable (≤2 mUI/L), suppressed (<8.2 mUI/L), and unsuppressed (≥8.2 mUI/L) direct renin concentration levels were also evaluated. RESULTS: Plasma aldosterone concentration, direct renin concentration, and blood pressure values were similar in non-MRA-treated (n=779) and MRA-treated (n=61) patients with PA, but the latter required more antihypertensive agents (P=0.001) and showed a higher rate of adrenal nodules (82% versus 67%; P=0.022) and adrenalectomy (72% versus 54%; P=0.01). However, they exhibited no significant differences in commonly used AVS indices and the area under the receiving operating characteristic curve of lateralization index, both under unstimulated conditions and postcosyntropin. Several sensitivity analyses confirmed these results in propensity score matching adjusted models and in patients with undetectable, or suppressed or unsuppressed renin levels. CONCLUSIONS: At doses that controlled blood pressure and potassium levels, MRAs did not preclude the identification of unilateral PA at AVS. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01234220.

Assistance Publique Hopitaux De Paris Hôpital Européen Georges Pompidou Hypertension Unit Paris France

Azienda Unità sanitaria locale Istituti di Ricovero e Cura a Carattere Scientifico

Department of Diabetes Endocrinology and Metabolism National Center for Global Health and Medicine Tokyo Japan

Department of Endocrinology and Metabolism 1 Faculty of Medicine and General University Hospital Prague Czech Republic

Department of Endocrinology Clinical Research Institute National Hospital Organization Kyoto Medical Center and Endocrine Center Ijinkai Takeda General Hospital Japan

Department of Endocrinology North Western State Medical University named after 1 I Mechnikov St Petersburg Russia

Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan

Department of Medical Imaging National Taiwan University Hospital Taipei

Department of Medicine 1st Faculty of Medicine and General University Hospital Prague Czech Republic

Department of Medicine 4 Ludwig Maximilian University of Munich

Department of Nephrology Endocrinology and Vascular Medicine Tohoku University Hospital Sendai

Department of Nephrology Medical Faculty University Hospital Düsseldorf Heinrich Heine University Düsseldorf Germany

Department of Translational Medicine Sapienza University of Rome Italy

Endocrinology in Charlottenburg Berlin Germany

Hypertension Unit Nephrology Department Hospital del Mar Universitat Pompeu Fabra Barcelona Spain

Internal Emergency Medicine Unit Department of Medicine Specialized Center for Blood Pressure Disorders Regione Veneto University of Padova Italy

Internal Medicine and Hypertension Center Ospedale Sant'Anna di Castelnovo Ne' Monti

Medical College of Wisconsin Endocrinology Center North Hills Health Center Menomonee Falls WI

Monash Health Clayton VIC Australia

National Taiwan University College of Medicine Taipei

Université Paris Cité Institut national de la santé et de la recherche médicale

University Medical Centre Ljubljana Faculty of Medicine University of Ljubljana Slovenia

University of Calgary Foothills Medical Centre Canada

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ClinicalTrials.gov
NCT01234220