Efficacy and Safety of Finerenone Compared to Spironolactone in Treatment of Primary Aldosteronism

Inclusion Criteria:

1. Age >18 years.
2. History of hypertension (blood pressure >140/90 mm Hg), both newly detected and already established patients.
3. Diagnosed case of primary aldosteronism (PA) based on a screening test (increased aldosterone renin ration (ARR) >70pmol/L) and confirmed by saline suppression test (post-saline PAC >170pmol/L, where PAC measured by immunoassay).
4. Serum potassium ≥2.5 mmol/L.

Exclusion Criteria:

1. Uncontrolled hypertension (>180/120 mm Hg).
2. Lateralized PA patients (aldosterone producing adenoma or unilateral hyperplasia) who want to undergo adrenalectomy or having aldosterone producing carcinoma.
3. Participants already with mineralocorticoid receptor antagonist treatment.
4. Patients receiving medications confounding PAC or PRC (glucocorticoids, sodium glucose co-transporter 2 inhibitors (SGLT-2i) or systemic therapy with potent cytochrome P450 isoenzyme 3A4 (CYP3A4) inhibitors (e.g. itraconazole, clarithromycin, rifampicin, carbamazepine, phenytoin, phenobarbital, efavirenz) that cannot be discontinued 14 days prior to randomization or for the duration of treatment period.
5. Abnormal renal function test: eGFR <60 ml/min-1.73m2.
6. Serum potassium level >5 mmol/L.
7. Recent cardiovascular events like acute myocardial ischemia, heart failure with hospitalization, stroke or transient ischemic attack ≤3 months before the screening visit.
8. Uncontrolled DM (HbA1C >12%)
9. Hepatic insufficiency (Child-Pugh C)
10. Addison's disease
11. Pregnant and lactating women. Women with child bearing potential must agree to use adequate contraception during and until 2 month of the end of study period.
12. Patient with other form of secondary HTN (e.g. renovascular HTN, Cushing syndrome, pheochromocytoma, coarctation of aorta etc.)
13. Known hypersensitivity to the study drugs.
14. Patients unwilling to participate in this study