Do you add an SGLT2 inhibitor to mineralocorticoid receptor antagonist therapy in a patient with primary aldosteronism who is not a surgical candidate, given retrospective data showing significantly lower mortality and cardiorenal events with the combination?

I have expanded the use of SGLT2-INHs beyond the core indications of HFrEF, DM2, and proteinuric CKD to include CV risk reduction for those at higher risk. Patients with primary aldosteronism often have a high ASCVD risk by PREVENT risk calculator, and would benefit from SGLT2-INH use.