Appropriate Mineralocorticoid Receptor Antagonism and Salt Restriction Are Essential for Primary Aldosteronism Therapy

In patients with PA, aldosterone secretion is renin-independent and autonomous [1]; therefore, salt reduction itself cannot suppress MR activity sufficiently, while it is effective in lowering blood pressure. Importantly, appropriate suppression of MR activity by titrating the MRA dose in addition to salt reduction may be the principle of PA medical treatment, possibly contributing to the cardiovascular event risk reduction. Although PA is a well-established disease entity, evidence is still accumulating on which measures of treatment improve prognosis in PA patients undergoing MRA therapy. Yoshida et al. allowed us to reconsider the role of MR activity and salt reduction, which may be important milestones in PA treatment. We believe their work could provide a novel perspective on better clinical management and pharmacotherapy for PA, which may contribute to improved cardiovascular outcomes in this patient population.