Can Primary Aldosteronism Treatment Reverse Heart Damage?

Yes, treatment for primary aldosteronism can help reverse some of the heart damage caused by the condition. Whether your treatment involves surgery to remove an overactive adrenal gland (adrenalectomy) or taking targeted medications to block aldosterone (mineralocorticoid receptor antagonists, or MRAs), these treatments do more than just lower your blood pressure. Clinical evidence shows that effective treatment can help shrink thickened heart muscle, improve arterial flexibility, and lower the long-term risk of cardiovascular events ^[1][2]. While the damage does not disappear completely for everyone, many patients experience significant improvements, and their cardiovascular risk is reduced, though not entirely eliminated ^[1].

How Treatments are Chosen

The best treatment for protecting your heart depends on the underlying cause of your primary aldosteronism ^[3]:

• Surgery (Adrenalectomy): This is generally considered if specialized testing (such as adrenal vein sampling) confirms that the excess aldosterone is coming from a nodule in only one adrenal gland (unilateral disease) ^[3]. A nodule on a CT scan is not enough on its own to prove unilateral disease.
• Medical Therapy (MRAs): Medications like spironolactone or eplerenone are used when both adrenal glands are overactive (bilateral disease), or if surgery is not desired or not a safe option ^[3].

Improving Heart Muscle Thickening (LVH)

Excess aldosterone and high blood pressure force your heart to pump harder, which can cause the walls of its main pumping chamber to thicken. This is a condition known as left ventricular hypertrophy (LVH) ^[1]. Both surgical and medical treatments can help reduce this thickening ^[4].

• How often it improves: In one long-term observational study that followed patients for about four years, just over half (54%) of the treated patients saw their LVH regress back to a normal size ^[1].
• Surgery vs. Medication: Both approaches are effective. Observational studies suggest patients who have an adrenalectomy often see a slightly greater average reduction in heart muscle mass ^[4][5]. However, this may partly reflect differences in baseline health between patients selected for surgery and those treated medically.
• Factors that help: Complete regression of LVH is more likely if the disease is treated before blood pressure and aldosterone levels have been severely elevated for a long time ^[1].

Softening Stiff Blood Vessels

Excess aldosterone can also cause your arteries to become rigid and stiff ^[6]. This arterial stiffness is measured by how fast blood pulses through your vessels. Research shows that both surgery and MRA medications can improve the flexibility of your arteries ^[7][8]. Some studies suggest much of this measurable improvement occurs during the first 6 to 12 months of targeted treatment ^[6], though these measurements are markers of vascular health rather than a guarantee that the arteries are completely restored.

Lowering Long-Term Cardiovascular Risks

Treating primary aldosteronism is associated with a lower long-term risk of major adverse cardiovascular events (MACE)—a research category that generally includes heart attacks, heart failure, and strokes ^[2][9].

In observational studies, patients who underwent an adrenalectomy for unilateral disease had lower rates of heart failure, strokes, and irregular heartbeats (atrial fibrillation) compared to those on medical therapy ^[2][10]. However, because these studies are observational rather than randomized, the people selected for surgery may have had different baseline risks than those treated medically. Ultimately, both treatments lower the risk of these events compared to leaving the condition untreated.

Medical Therapy: The Role of Renin

If you are treating your primary aldosteronism with MRAs, simply having a normal blood pressure reading does not fully prove your heart is protected from excess aldosterone ^[3][11].

To help gauge if your MRA dose is adequate, doctors often monitor renin, a hormone system enzyme produced by your kidneys. When aldosterone levels are dangerously high, your body stops making renin (meaning it is “suppressed”). When an MRA dose is high enough to effectively block the excess aldosterone, your body may start making renin again (meaning it becomes “unsuppressed”) ^[12].

Observational studies associate unsuppressed renin with a lower risk of future heart attacks and strokes compared to when renin remains suppressed ^[12][13]. However, an unsuppressed renin is a marker of treatment response, not a direct measurement of heart healing.

Safety Monitoring for MRA Medications

While MRA medications are highly effective, taking them requires careful medical supervision. Spironolactone and eplerenone can increase blood potassium levels and affect your kidney function ^[3].

To keep you safe, your care team will require regular blood tests to monitor your potassium and a kidney marker called creatinine, especially when you first start the medication or change your dose. Never adjust your MRA dose on your own. Additionally, because of the risk of dangerously high potassium (hyperkalemia), you should never take potassium supplements, use salt substitutes containing potassium, or start new medications (like ibuprofen or certain blood pressure drugs) without consulting your doctor.