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Association of achieved blood pressure after treatment for primary aldosteronism with long-term kidney function


Little is known regarding the association of blood pressure (BP) after treatment for primary aldosteronism (PA) (i.e., adrenalectomy and mineralocorticoid receptor antagonists) with long-term renal outcomes, and whether the association is independent of BP before treatment. Using a dataset from a nationwide registry of PA in Japan, we assessed whether achieved BP levels 6 months after treatment for PA are associated with annual changes in estimated glomerular filtration rate (eGFR), rapid eGFR decline, and incident chronic kidney disease (CKD) during the 5-year follow-up period. The cohort included 1266 PA patients. In multivariable linear regression including systolic BP (SBP) levels before treatment for PA, estimates (95% confidence interval [CI]) for annual changes in eGFR after month 6 associated with one-standard deviation (1-SD) higher SBP at month 6 were –0.08 (–0.15, –0.02) mL/min/1.73 m2/year. After multivariable adjustment, the estimate (95% CI) for annual changes in eGFR after month 6 was –0.12 (–0.21, –0.02) for SBP ≥ 130 mmHg vs. SBP < 130 mmHg at month 6. Among 537 participants without CKD at baseline, a 1-SD higher SBP was associated with a higher risk for incident CKD events (hazard ratio [95% CI]: 1.40 [1.00, 1.94]). Higher SBP after treatment for PA was associated with a higher risk for kidney dysfunction over time, independently of BP levels before treatment. Achieving SBP lower than 130 mmHg after treatment for PA may be linked to better kidney outcomes.

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We thank the JPAS/JRAS members for collecting the clinical data.


This study was conducted as a part of the JPAS and JRAS by a research grant from the Japan Agency for Medical Research and Development (grant numbers JP17ek0109122 and JP20ek0109352), and the National Center for Global Health and Medicine, Japan (27-1402, 30-1008).

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TH, Y. Yano, KT and MN designed the study; TH carried out the analyses; TH and Y. Yano drafted the manuscript; and YH, KT, IK, HK, MT, TI, NW, T. Katabami, KY, SO, T. Kai, SI, Y. Yoshikawa, MY, YC, AT and MN revised the paper.

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Correspondence to Yuichiro Yano or Kouichi Tamura.

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The authors declare no competing interests.

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Haze, T., Yano, Y., Hatano, Y. et al. Association of achieved blood pressure after treatment for primary aldosteronism with long-term kidney function. J Hum Hypertens (2021).

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