Low-renin hypertension in incidental adrenal adenomas and response to aldosterone-targeted therapy: a prospective study
Fecha
2026-06-27
Nota de Acceso
Fecha de embargo
Profe guía
Perfil ORCID
Título de la revista
ISSN de la revista
Título del volumen
Editor
Elsevier
ISBN
ISSN
0953-6205
ISSNe
Resumen
Background: Incidental adrenal adenomas are common, yet renin status is infrequently assessed in hypertensive
patients. Emerging evidence supports a spectrum of renin-independent aldosterone excess associated with
adverse cardiovascular risk.
Objective and methods: To determine the frequency of a low-renin phenotype in a prospective cohort of hypertensive
patients with adrenal adenomas and to evaluate the clinical response to aldosterone-targeted therapy
across baseline aldosterone categories. Low-renin phenotype was defined as suppressed renin (PRA <1.0 ng/mL/
h or DRC <10 μIU/mL). Among these patients, plasma aldosterone concentration (PAC) was categorized as 5–10
ng/dL (Group 1), 10–15 ng/dL (Group 2), and >15 ng/dL (Group 3). Patients with suppressed renin were treated
with MR antagonists or adrenalectomy and followed longitudinally using PAMO/PASO criteria.
Results: Low renin was present in 47% (138/290) of hypertensive patients. Increasing aldosterone levels were
associated with higher systolic blood pressure (SBP), resistant hypertension, higher antihypertensive treatment
burden, lower potassium, and reduced eGFR (p-trend <0.001). After a mean follow-up of 24±18 months (n =
121), aldosterone-targeted therapy (75% medical, 25% surgical) led to significant reductions in SBP (-18, -26,
and -30 mmHg across Groups 1–3; all p < 0.001), decreased medication and significant increases in renin (all p <
0.001), irrespective of aldosterone category.
Conclusions: Nearly half of hypertensive patients with adrenal incidentalomas exhibit suppressed renin levels
associated with greater blood pressure burden and favorable response to aldosterone-targeted therapy, even in
lower aldosterone levels categories. These findings support systematic renin assessment in hypertensive patients
with incidental adrenal adenomas and provide a rationale for testing aldosterone-targeted therapy in broader
hypertensive populations beyond adrenal adenomas
Descripción
Lugar de Publicación
Netherlands
Sponsorship
Citación
European Journal of Internal Medicine, (2026), Article 107042
Palabras clave
Adrenal adenomas, Low renin hypertension, Aldosterone dysregulation, Hypertension, Primary aldosteronism, Mineralocorticoid receptor, Adrenal incidentaloma
Licencia
Atribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)