Sex Differences in Renal Outcomes After Medical Treatment for Bilateral Primary Aldosteronism.

Abstract

A higher incidence of bilateral primary aldosteronism in women is reported. Treatment of bilateral primary aldosteronism usually involves mineralocorticoid receptor antagonists. However, the impact of sex on renal outcomes is unknown. We compared renal outcomes between the sexes after mineralocorticoid receptor antagonist initiation by analyzing data obtained from 415 female and 313 male patients with bilateral primary aldosteronism who were treated with spironolactone or eplerenone in the JPAS (Japan Primary Aldosteronism Study). Over the course of 5 years, the temporal reduction in the estimated glomerular filtration rate was greater in women than in men (P<0.001). Systolic blood pressure levels were equal between the sexes, despite higher doses of antihypertensive drugs in men. The mean of the annual decline in estimated glomerular filtration rate during what we termed the late phase, or 6 to 60 months after mineralocorticoid receptor antagonist initiation, was larger in women than in men after adjusting for patient characteristics (-1.33 mL/min per 1.73 m2 per year versus -1.04 mL/min per 1.73 m2 per year, P<0.01). Female sex was a significant predictor of greater annual decline during the late phase in patients taking spironolactone but not in those taking eplerenone. Spironolactone use and diabetes were independent predictors of a greater annual decline in estimated glomerular filtration rate during the late phase in women. These findings suggest that female sex is associated with poorer renal outcomes in patients receiving mineralocorticoid receptor antagonist for bilateral primary aldosteronism.

• Authors: Ryo Nakamaru, Koichi Yamamoto, Hiroshi Akasaka, Hiromi Rakugi, Isao Kurihara, Takashi Yoneda, Takamasa Ichijo, Takuyuki Katabami, Mika Tsuiki, Norio Wada, Tetsuya Yamada, Hiroki Kobayashi, Kouichi Tamura, Yoshihiro Ogawa, Junji Kawashima, Nobuya Inagaki, Megumi Fujita, Kenji Oki, Kohei Kamemura, Akiyo Tanabe, Mitsuhide Naruse, JPAS/JRAS study group
• Journal: Hypertension (Dallas, Tex. : 1979) (Hypertension) Vol. 77 Issue 2 Pg. 537-545 (02 2021) ISSN: 1524-4563 [Electronic] United States
• PMID: 33356395 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Mineralocorticoid Receptor Antagonists
• Spironolactone
• Eplerenone

Topics

• Adult
• Blood Pressure (drug effects)
• Eplerenone (pharmacology, therapeutic use)
• Female
• Glomerular Filtration Rate (drug effects)
• Humans
• Hyperaldosteronism (drug therapy)
• Kidney (drug effects)
• Male
• Middle Aged
• Mineralocorticoid Receptor Antagonists (pharmacology, therapeutic use)
• Sex Factors
• Spironolactone (pharmacology, therapeutic use)