Efficacy and safety of medical treatment of primary aldosteronism: a real-world data study in Spain
Authors' conclusion
This study underscores the need to optimize PA medical management in Spain to improve patient clinical and biochemical outcomes, since currently the proportion of patients achieving complete clinical and biochemical response with MRA is quite low.
Study context
- Population
- Patients with primary aldosteronism (PA) in Spain, SPAIN-ALDO registry880 with ≥1 follow-up visit
- Participants
- 997 patients
- Exposure
- Adrenalectomy vs mineralocorticoid receptor antagonist (MRA) as first-line therapy
- Adrenalectomyn = 322
- MRA first-linen = 511reference
- MRA postsurgeryn = 47
- Outcome
- Complete biochemical and clinical response (PASO/PAMO criteria)
- Follow-up
- Median 35 (medical) and 17 (surgical) months
Methodological detailsnational, multicentre, registry (SPAIN-ALDO), real-world data
- National
- Multicentre
- Registry (SPAIN-ALDO)
- Real-world data
Main finding
As reported in the abstract
median follow-up 35 (medical) and 17 (surgical) months
| Outcome | Adrenalectomy | MRA first-line |
|---|---|---|
| Complete biochemical response | 68.1% | 48.6% |
| Complete clinical response | 33.6% | 15.7% |
- Adrenalectomy vs MRA first-line: P < 0.001 — complete responses more frequent with adrenalectomy
Observational data: associations, not effects.
Further findings
Antihypertensive classes most used before PA diagnosis
- Calcium-channel blockers
- 66%
- Angiotensin II receptor blockers
- 48.4%
MRA dosing and prescription
- Median defined daily dose of MRA
- 1.33
- Spironolactone vs eplerenone prescribed
- 58% vs 42%
Safety
AEs
Adverse events (AEs)
- Eplerenone better tolerated than spironolactone, particularly among males
Original publication
Efficacy and safety of medical treatment of primary aldosteronism: a real-world data study in Spain. Eur J Endocrinol. Published 31 July 2025. doi:10.
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