Low-renin hypertension in incidental adrenal adenomas and response to aldosterone-targeted therapy: a prospective study

Vista sencilla de ítem
dc.contributor.authorUslar, Thomas
dc.contributor.authorSanfuentes, Benjamín
dc.contributor.authorOlmos, Roberto
dc.contributor.authorBurnier, Alberth
dc.contributor.authorBöhm, Pauline
dc.contributor.authorGuarda, Francisco J.
dc.contributor.authorHuete, Álvaro
dc.contributor.authorMertens, Nicolás
dc.contributor.authorBesa, Cecilia
dc.contributor.authorAndía, Marcelo
dc.contributor.authorMajerson, Alejandro
dc.contributor.authorCartes, Jaime
dc.contributor.authorTapia-Castillo, Alejandra
dc.contributor.authorCarvajal, Cristian A.
dc.contributor.authorFardella, Carlos E.
dc.contributor.authorAllende, Fidel
dc.contributor.authorSolari, Sandra
dc.contributor.authorVaidya, Anand
dc.contributor.authorBaudrand, Rene
dc.coverage.spatialNetherlands
dc.date.accessioned2026-07-21T19:35:33Z
dc.date.available2026-07-21T19:35:33Z
dc.date.issued2026-06-27
dc.description.abstractBackground: 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
dc.identifier.citationEuropean Journal of Internal Medicine, (2026), Article 107042
dc.identifier.doihttps://doi.org/10.1016/j.ejim.2026.107042
dc.identifier.issn0953-6205
dc.identifier.orcidhttps://orcid.org/0000-0002-6081-1468
dc.identifier.urihttps://hdl.handle.net/20.500.12254/7674
dc.language.isoen
dc.publisherElsevier
dc.rightsAtribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)
dc.rights.urihttp://creativecommons.org/licenses/by-nc-sa/3.0/cl/
dc.subjectAdrenal adenomas
dc.subjectLow renin hypertension
dc.subjectAldosterone dysregulation
dc.subjectHypertension
dc.subjectPrimary aldosteronism
dc.subjectMineralocorticoid receptor
dc.subjectAdrenal incidentaloma
dc.titleLow-renin hypertension in incidental adrenal adenomas and response to aldosterone-targeted therapy: a prospective study
dc.typeArticle
Archivos
Bloque original
Mostrando 1 - 1 de 1
No hay miniatura disponible
Nombre:
1-s2.0-S095362052600347X-main.pdf
Tamaño:
804.88 KB
Formato:
Adobe Portable Document Format
Descargar
Bloque de licencias
Mostrando 1 - 1 de 1
No hay miniatura disponible
Nombre:
license.txt
Tamaño:
347 B
Formato:
Item-specific license agreed upon to submission
Descripción:
Descargar
Colecciones
Artículos de Revistas