Primary aldosteronism (PA) is the most common cause of secondary hypertension but is frequently underrecognized and undertreated. Patients with PA are at a markedly increased risk for target organ damage to the heart and kidneys. While patients with unilateral PA can be treated surgically, many patients with PA are not eligible or willing to undergo surgery. Steroidal mineralocorticoid receptor antagonists (MRAs) are highly effective for treating PA and reducing the risk of target organ damage. However, steroidal MRAs are often underprescribed and can be poorly tolerated by some patients due to side effects. Nonsteroidal MRAs reduce adverse renal and cardiovascular outcomes among patients with diabetic kidney disease and are bettertolerated than steroidal MRAs. While their blood pressure–lowering effects remain unclear, these agents may have a potential role in reducing target organ damage in patients with PA.

中文翻译：

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原发性醛固酮增多症和盐皮质激素受体拮抗剂对心脏和肾脏的作用

原发性醛固酮增多症 (PA) 是继发性高血压的最常见原因，但常常未被充分认识和治疗。 PA 患者心脏和肾脏靶器官损伤的风险显着增加。虽然单侧 PA 患者可以接受手术治疗，但许多 PA 患者不符合或不愿意接受手术。类固醇盐皮质激素受体拮抗剂 (MRA) 对于治疗 PA 和降低靶器官损伤的风险非常有效。然而，类固醇 MRA 的处方常常不足，并且由于副作用，一些患者的耐受性较差。非类固醇 MRA 可减少糖尿病肾病患者的不良肾脏和心血管结局，并且比类固醇 MRA 具有更好的耐受性。虽然它们的降血压作用尚不清楚，但这些药物可能在减少 PA 患者靶器官损伤方面具有潜在作用。