Primary
aldosteronism is the most common cause of secondary
hypertension, accounting for about 10% of all forms of
high blood pressure. Life-time pharmacological
therapy is the treatment of choice for primary
aldosteronism due to idiopathic adrenal
hyperplasia (IHA), while
adrenalectomy is effective in curing most patients with an
aldosterone producing
adenoma (APA). Far from being a benign form of
hypertension, primary aldosteronism is characterized by the development of cardiovascular renal and metabolic complications, including
left ventricular hypertrophy,
myocardial infarction,
atrial fibrillation and
stroke, microalbuminuria, renal
cysts as well as
metabolic syndrome,
glucose impairment and
diabetes mellitus. We review recent clinical experience with the above mentioned complications and long-term outcomes of blood pressure normalization and cardiac, renal and gluco-metabolic complications in patients with primary
aldosteronism, after medical treatment with
mineralocorticoid receptor antagonists and surgical treatment. We conclude that removal of adrenal
adenoma results in normalization of the renin-angiotensin-aldosterone system (RAAS) and of kalaemia and improvement of blood pressure levels in all patients. Complete resolution of
hypertension is achieved in nearly half of treated patients. Moreover, unilateral
adrenalectomy is the best treatment to have the regression of cardiovascular, renal and metabolic complications in patients with APA. On the other hand, targeted medical treatment with
aldosterone antagonists improves blood pressure control and appears able to prevent the progression of cardiac and metabolic complications in patients with IHA.