Primary Aldosteronism & Resistant Hypertension - Prof. Dr. Morris Brown (London, UK)

Dr. Morris Brown presents the current knowledge on pathogenesis, diagnosis and treatment of primary hyperaldosteronism, and on aldosterone-synthesis inhibitors as a drug class in resistant hypertension.
Dr. Morris Brown is Professor of Endocrine Hypertension at Queen Mary University of London, and the William Harvey Heart Centre, London, UK. He is past president of the British Hypertension Society, and conducted landmark studies on antihypertensive treatment, including PATHWAY 1, 2 and 3, TIME, BrigHTN, INSIGHT and ACCELERATE. He also published seminal studies on the pathogenesis of primary hyperaldosteronism.

The interview was recorded on October 16th, 2023.

Moderators: Prof. Dr. Marcus Säemann (Vienna, Austria), Prof. Dominique Guerrot (Rouen, France) and Prof. Dr. Gunnar Heine (Frankfurt, Germany).

Articles discussed:

Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies.
Williams B, ..., Brown MJ; British Hypertension Society programme of Prevention And Treatment of Hypertension With Algorithm based Therapy (PATHWAY) Study Group.
Lancet Diabetes Endocrinol. 2018
doi: 10.1016/S2213-8587(18)30071-8

Effect of AZD9977 and spironolactone on serum potassium in heart failure with preserved or mildly reduced ejection fraction, and renal impairment: A randomized trial.
Squire IB et al.
Clin Transl Sci. 2022
doi: 10.1111/cts.13377

A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease.
Filippatos G, ..., Pitt B.
Eur Heart J. 2016
doi: 10.1093/eurheartj/ehw132.

Inhibition of aldosterone synthase: Does this offer advantages compared with the blockade of mineralocorticoid receptors?
Ando H.
Hypertens Res. 2023
doi: 10.1038/s41440-023-01188-z.

Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis.
Agarwal R, Filippatos G, Pitt B, Anker SD, Rossing P, Joseph A, Kolkhof P, Nowack C, Gebel M, Ruilope LM, Bakris GL; FIDELIO-DKD and FIGARO-DKD investigators.
Eur Heart J. 2022
doi: 10.1093/eurheartj/ehab777.

Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT).
Brown MJ et al.
Lancet. 2000
doi: 10.1016/S0140-6736(00)02527-7

Medical Research Council trial of treatment of hypertension in older adults: principal results.
MRC Working Party.
BMJ. 1992
doi: 10.1136/bmj.304.6824.405.

Effect of amiloride, or amiloride plus hydrochlorothiazide, versus hydrochlorothiazide on glucose tolerance and blood pressure (PATHWAY-3): a parallel-group, double-blind randomised phase 4 trial.Brown MJ et al.; British Hypertension Society's Prevention and Treatment of Hypertension with Algorithm-based Therapy (PATHWAY) Studies Group.
Lancet Diabetes Endocrinol. 2016
doi: 10.1016/S2213-8587(15)00377-0

Telmisartan, ramipril, or both in patients at high risk for vascular events.
ONTARGET Investigators; Yusuf S et al.
N Engl J Med. 2008
doi: 10.1056/NEJMoa0801317

Phase 2 Trial of Baxdrostat for Treatment-Resistant Hypertension.Freeman MW, ..., Brown MJ; BrigHTN Investigators.N Engl J Med. 2023doi: 10.1056/NEJMoa2213169.Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial.
Williams B, ..., Brown MJ; British Hypertension Society's PATHWAY Studies Group.
Lancet. 2015
doi: 10.1016/S0140-6736(15)00257-3.

The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study.
Brown JM, Siddiqui M, Calhoun DA, Carey RM, Hopkins PN, Williams GH, Vaidya A.
Ann Intern Med. 2020
doi: 10.7326/M20-0065

The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline.
Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF Jr.
J Clin Endocrinol Metab. 2016
doi: 10.1210/jc.2015-4061

[11C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: a prospective, within-patient trial.
Wu X, Brown MJ.
Nat Med. 2023
doi: 10.1038/s41591-022-02114-5

Primary aldosteronism: molecular medicine meets public health.
Azizan EAB, Drake WM, Brown MJ.
Nat Rev Nephrol. 2023
doi: 10.1038/s41581-023-00753-6

Somatic mutations of CADM1 in aldosterone-producing adenomas and gap junction-dependent regulation of aldosterone production.
Wu X, Azizan EAB, ..., Brown MJ.
Nat Genet. 2023
doi: 10.1038/s41588-023-01403-0.

Who and How Should We Screen for Primary Aldosteronism?
Funder JW.
Hypertension. 2023
doi: 10.1161/HYPERTENSIONAHA.123.20536