Treating primary aldosteronism-induced hypertension: novel approaches and future outlooks.
Nathan MullenJames CurneenPadraig T DonlonPunit PrakashIrina BancosMark GurnellMichael Conall DennedyPublished in: Endocrine reviews (2023)
Primary aldosteronism (PA) is the most common cause of secondary hypertension and is associated with increased morbidity and mortality when compared to blood pressure-matched cases of primary hypertension. Current limitations in patient care stem from delayed recognition of the condition, limited access to key diagnostic procedures, and lack of a definitive therapy option for non-surgical candidates. However, several recent advances have the potential to address these barriers to optimal care. From a diagnostic perspective, machine learning algorithms have shown promise in the prediction of PA subtypes, while the development of non-invasive alternatives to adrenal vein sampling (including molecular PET imaging) has made accurate localisation of functioning adrenal nodules possible. In parallel, more selective approaches to targeting the causative aldosterone-producing adrenal adenoma/nodule (APA/APN) have emerged with the advent of partial adrenalectomy or precision ablation. Additionally, the development of novel pharmacological agents may help to mitigate off-target effects of aldosterone and improve clinical efficacy and outcomes. Here, we consider how each of these innovations might change our approach to the patient with PA, to allow more tailored investigation and treatment plans, with corresponding improvement in clinical outcomes and resource utilisation, for this highly prevalent disorder.
Keyphrases
- blood pressure
- machine learning
- pet imaging
- hypertensive patients
- heart rate
- healthcare
- palliative care
- angiotensin ii
- artificial intelligence
- type diabetes
- blood glucose
- squamous cell carcinoma
- computed tomography
- high glucose
- health insurance
- locally advanced
- diabetic rats
- pain management
- affordable care act
- radiation therapy
- atrial fibrillation
- mass spectrometry
- replacement therapy
- human health
- chronic pain
- arterial hypertension
- mesenchymal stem cells
- risk assessment