Response to Effectiveness of adrenalectomy and aldosterone antagonists for long-term treatment of primary aldosteronism

Our data demonstrated the efficacy of mineralocorticoid receptor (MR) blockers for the treatment of primary aldosteronism (PA).1 However, by no means did we interpret our findings to show the superiority of adrenalectomy over MR blocker therapy. The higher rate of cure of hypertension seen with surgery was intrinsic with the definition of cure: 42% of our adrenalectomized versus none of our medically treated patients could withdraw pharmacological treatment at long term. Hence, when guided by results of adrenal vein sampling, adrenalectomy provides long-term cure of hypertension and allows tapering, or withdrawal, of the antihypertensive medications. Comparing adrenalectomy and MR blockade would require randomization of PA patients to either treatment. Neither the study of Reincke et …