Adherence and blood pressure control in patients with primary aldosteronism

To evaluate the adherence to MR antagonists and other antihypertensive therapy and blood pressure control in conservatively treated patients with primary aldosteronism.We have consecutively investigated in an outpatient hypertension clinic conservatively treated subjects with previously confirmed primary aldosteronism (PA) (n- 50, 64,5 ± 9 years of age, 24% of women). The confirmation of PA was based on saline supression test in accordance with current guidelines. The PA patients were conservatively treated due to bilateral disease confirmed by adrenal venous sampling or refusal of the surgery. All subjects were regularly followed-up in our clinic. In addition to basic laboratory and clinical parameters, 24 hour ambulatory blood pressure monitoring (Spacelabs) was evaluated. Unplanned blood sampling for assesment of all serum antihypertensive drug concentrations by means of liquid chromatography-mass spectrometry was performed in all patients. The drug was considered positive when the concentration was at least at the lowest detectable level. Total noncompliance was defined as the absence of all measured antihypertensive drugs. Partial noncompliance was calculated as the absence of serum levels of at least one, but not all antihypertensive drugs apparently taken.We have detected good blood pressure control (mean 24 h systolic/diastolic BP 130 ± 12/77 ± 9 mmHg). Average number of antihypertensive drugs was 3,9 ± 1,5. All subjects were treated by MR antagonists. 44% of patients received spironolactone (average daily dose 45 ± 20 mg) and in remaining 56% of subjects eplerenon was given (average daily dose 80 ± 30 mg) because of spironolactone side effects. Assesment of antihypertensive drug concentrations revealed full adherence in 80 %, partial nonadherence was noted in remaining 20 % of subjects. MR antagonists were detected in almost all subjects (49 out of 50).We have detected very good blood pressure control and adherence in conservatively treated patients with primary aldosteronism. Eplerenone had to be used due to spironolactone side effects quite often. Combination of MR antagonists with other antihypertensive drugs (mainly calcium channel blockers and thiazides) had to be used in majority of patients with PA.