Effects of Aldosterone Blockade on Metabolic and Renal Factors in Patients with Primary Aldosteronism

Objective: The mineralocorticoid Receptor (MR) is expressed not only in the kidneys but also in adipose tissue, and primary aldosteronism (PA) is associated with metabolic syndrome. This study assessed the effects of aldosterone blockade on metabolic factors in patients with PA. Method: Sixty-five patients with PA were treated with one of two MR antagonists; eplerenone (50-100 mg, daily, n=38) or spironolactone (25-50 mg, daily, n=27) for 14 months. Visceral (VAT) and subcutaneous adipose tissue (SAT) were quantified using CT and “Fat Scan” imaging analysis software. Body mass index (BMI), homeostasis model assessment-insulin resistance (HOMA-IR), serum creatinine, potassium and lipids, urinary albumin excretion and plasma aldosterone (PAC) and PRA were measured before and after treatment. Results: Eplerenone and spironolactone decreased blood pressure and increased serum potassium levels similarly. PAC and PRA did not differ among the two groups. Although treatment with the MR antagonists did not change HOMAIR or serum lipids, they significantly decreased urinary albumin excretion and V A T (p<0.05). Conclusion: These results suggest that both eplerenone and spironolactone are effective and safe for treatment of PA. The long-term metabolic effects of these MR antagonists should be further investigated. Sixty-five patients with primary aldosteronism (PA) were treated with eplerenone or spironolactone for 14 months. Visceral (VAT) and subcutaneous adipose tissue (SAT), Body Mass Index (BMI), homeostasis model assessment-insulin resistance (HOMA-IR), serum creatinine, potassium and lipids, and urinary albumin excretion were measured before and after treatment. Eplerenone and spironolactone decreased blood pressure and increased serum potassium levels similarly. Although treatment with the MR antagonists did not change HOMA-IR, they significantly decreased urinary albumin excretion and VAT (p<0.05). These results suggest that both eplerenone and spironolactone are effective for blood pressure and improvement of metabolic factors.