{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T03:25:59Z","timestamp":1785209159127,"version":"3.55.0"},"reference-count":35,"publisher":"The Endocrine Society","issue":"11","license":[{"start":{"date-parts":[[2021,8,31]],"date-time":"2021-08-31T00:00:00Z","timestamp":1630368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001349","name":"Singapore National Medical Research Council","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"crossref"}]},{"name":"A*Star Biomedical Research Council"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Patients with primary aldosteronism (PA) have increased cardiovascular risk, and there are concerns about the efficacy of medical therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We aimed to assess long-term tolerability and efficacy of medical therapy in PA patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective study on 201 PA patients treated with medical therapy (spironolactone, eplerenone, or amiloride) from 2000 to 2020 at 2 tertiary centers. Clinical and biochemical control and side effects were assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 155 patients on long-term medications, 57.4% achieved blood pressure (BP) &amp;lt;140\/90 mmHg, 90.1% achieved normokalemia (48.0% potassium \u22654.3 mmol\/L), and 63.2% achieved renin &amp;gt;1 ng\/mL\/h. Concordance of biochemical control using potassium and renin levels was 49.1%. Side effects were experienced by 52.3% of patients, with 10.3% switching, 22.6% decreasing dose, and 11.0% stopping medications. Risk factors for side effects were spironolactone use, dose \u2265 50 mg, treatment duration \u22651 year, male gender, and unilateral PA. Patients with unilateral PA used higher spironolactone doses vs bilateral (57 vs 50 mg, P &amp;lt; 0.001) and had more side effects (63.2% vs 41.8%, P = 0.008). Forty-six unilateral PA patients who underwent surgery after initial medical therapy experienced improved BP (systolic from 141 to 135 mmHg, P = 0.045; diastolic from 85 to 79 mmHg, P = 0.002).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Dose-dependent side effects limit efficacy of medical therapy in PA. Future prospective studies should assess the best monitoring strategy for biochemical control during long-term medical therapy. For unilateral PA, surgery remains preferable, yielding better control with less long-term side effects.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/jendso\/bvab144","type":"journal-article","created":{"date-parts":[[2021,8,31]],"date-time":"2021-08-31T12:21:30Z","timestamp":1630412490000},"source":"Crossref","is-referenced-by-count":18,"title":["Tolerability and Efficacy of Long-Term Medical Therapy in Primary Aldosteronism"],"prefix":"10.1210","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1560-3221","authenticated-orcid":false,"given":"Fengjie","family":"Tang","sequence":"first","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lih M","family":"Loh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger S","family":"Foo","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, Centre for Translational Medicine, MD6, National University Health System, Singapore 117599, Singapore"},{"name":"Genome Institute of Singapore, Singapore 138672, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wann J","family":"Loh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn S T","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meifen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei T","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Clinical Trial Research Unit, Changi General Hospital, SingHealth, Singapore 529889, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Du S","family":"Swee","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Khoo","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donovan","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sengkang General Hospital, SingHealth, Singapore 544886, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynette","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore"},{"name":"Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Y","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore"},{"name":"Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shui B","family":"Soh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eberta","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng C","family":"Kek","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Singapore General Hospital, SingHealth, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8047-5836","authenticated-orcid":false,"given":"Troy H","family":"Puar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Changi General Hospital, SingHealth, Singapore 529889, 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