Michio Otsuki    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor and Division head
Article types	Original article
Language	English
Peer review	Peer reviewed
Title	Association of cardiovascular disease risk and changes in renin levels by mineralocorticoid receptor antagonists in patients with primary aldosteronism.
Journal	Formal name：Hypertension research : official journal of the Japanese Society of Hypertension Abbreviation：Hypertens Res ISSN code：13484214/09169636
Domestic / Foregin	Domestic
Volume, Issue, Page	45(9),pp.1476-1485
Author and coauthor	Nomura Motoko, Kurihara Isao, Itoh Hiroshi, Ichijo Takamasa, Katabami Takuyuki, Tsuiki Mika, Wada Norio, Yoneda Takashi, Sone Masakatsu, Oki Kenji, Yamada Tetsuya, Kobayashi Hiroki, Tamura Kouichi, Ogawa Yoshihiro, Inagaki Nobuya, Yamamoto Koichi, Otsuki Michio, Yabe Daisuke, Izawa Shoichiro, Takahashi Yutaka, Suzuki Tomoko, Yasoda Akihiro, Tanabe Akiyo, Naruse Mitsuhide,
Publication date	2022/09
Summary	A recent report stated that patients with primary aldosteronism who remain renin suppressed during mineralocorticoid receptor antagonist treatment might have a higher risk of developing cardiovascular disease than those with unsuppressed renin activity. We retrospectively investigated the incidence of composite cardiovascular disease and risk factors for cardiovascular disease in 1115 Japanese patients with primary aldosteronism treated with mineralocorticoid receptor antagonists. The median follow-up period was 3.0 years, and the incidence of cardiovascular events was very low (2.1%) throughout 5 years of follow-up. Changes in plasma renin activity from before to after mineralocorticoid receptor antagonist treatment were divided into three groups based on tertile, low, intermediate, and high plasma renin activity change groups, with incidences of cardiovascular disease events of 2.1%, 0.5%, and 3.7%, respectively. Multivariate Cox regression analysis revealed age (adjusted hazard ratio, 1.07; 95% confidence interval, [1.02-1.12]) and body mass index (adjusted hazard ratio, 1.13 [1.04-1.23]) as independent risk factors for cardiovascular disease. The high plasma renin activity change group had significantly higher cardiovascular disease risk with mineralocorticoid receptor antagonist treatment than the intermediate plasma renin activity change group (adjusted hazard ratio, 5.71 [1.28-25.5]). These data suggest that a high change in renin level after mineralocorticoid receptor antagonist treatment may not necessarily predict a better prognosis of cardiovascular disease in patients with primary aldosteronism.
DOI	10.1038/s41440-022-00960-x
PMID	35764671