Mineralocorticoid Receptor Antagonists

In RETAME-PA, spironolactone is the preferred first-line MRA and may be titrated up to 400 mg per day. Blood pressure and serum potassium are indirect, non-specific measures of MRA therapeutic efficacy in primary aldosteronism. Low rates of renin unsuppression during MRA treatment suggest possible under-dosing, non-adherence, or biological barriers to aldosterone blockade. Higher MRA doses can cause clinically important harms including hyperkalaemia, acute kidney injury, orthostatic hypotension, and reduced quality of life. Mineralocorticoid receptor antagonists are standard pharmacological therapy for primary aldosteronism patients who do not undergo adrenalectomy.