THE CHARACTERISTICS OF PATIENTS SENSITIVE TO MINERALOCORTICOID RECEPTOR ANTAGONISTS

Abstract

Objective: Primary aldosteronism (PA) is related to various cardiovascular events, thus the treatment of this disease is exceedingly important. From the current guidelines, physicians are encouraged to administrate mineralocorticoid receptor antagonists (MRA) to the patients with bilateral type of this disease, so-called idiopathic hyperaldosteronism (IHA). However, it is recently demonstrated that the benefit of this medicine is only exerted in the patients with enough PRA elevation after MRA treatment. We retrospectively evaluated the predictors for the patients who exceed plasma renin activity (PRA) > 1.0 ng/ml/h at arbitrary chance after MRA administration from baseline characteristics and the result of confirmatory tests. Design and method: Our study protocol was approved by the Ethics Committee of The Jikei University School of Medicine (No. 31-271). 67 patients who received eplerenone for PA are included. We included the patients exceed plasma renin activity (PRA) > 1.0 ng/ml/h at arbitrary chance within a year after MRA administration in Group A, and the patients who did not were included in Group B. Results: The eplerenone dose was comparable in two groups (Group A: 47.7 ± 13.1 v.s. Group B: 46.7 ± 14.4 P = 0.78). The patients in Group A were younger, and baseline PRA was lower in Group A. PRA after furosemide upright test, plasma aldosterone concentration (PAC) after saline infusion test, and PAC and PAC/F (Cortisol) after rapid adrenocorticotropic hormone (ACTH) stimulation test were higher in the Group A. Above all, it is revealed with Receiver operating characteristic curve analyses that PAC/F after rapid ACTH stimulation test at the cut-off value of 12.4 was proved to have the highest Area Under Curve (AUC) among all the indices (AUC 0.770). Conclusions: In conclusion, rapid ACTH stimulation test might be useful for discriminating the patients sensitive to MRA treatment.