Calgary, Canada — Even though primary aldosteronism (PA) is one of the most common causes of secondary hypertension, the comparative outcomes of targeted treatment often are unclear.
A new study in the Journal of Clinical Endocrinology & Metabolism sought to compare the clinical outcomes in patients treated for primary aldosteronism over time.
To do that, the study team from the Cumming School of Medicine at the University of Calgary in Canada, the University of California (San Francisco) and the San Francisco VA Health Care System searched Medline and EMBASE. The researchers selected original studies reporting incidence of mortality, major adverse cardiovascular outcomes (MACE), progression to chronic kidney disease or diabetes following adrenalectomy vs. medical therapy.
For the study, two reviewers independently abstracted data and assessed study quality. Ultimately, 16 studies involving 15,541 patients with PA were included.
Results indicated that surgery was consistently associated with an overall lower risk of death (HR, 0.34 [95% CI, 0.22 to 0.54]) and MACE (HR, 0.55 [95% CI, 0.36 to 0.84]), compared to medical therapy. Surgery was associated with a significantly lower risk of hospitalization for heart failure (HR, 0.48 [95% CI, 0.34 to 0.70]) and progression to chronic kidney disease (HR, 0.62 [95% CI, 0.39 to 0.98]) and nonsignificant reductions in myocardial infarction and stroke.
“In absolute terms, 200 patients would need to be treated with surgery instead of medical therapy to prevent 1 death after 12.3 (95% CI, 3.1 to 48.7) months,” the researchers advised.
They concluded that surgery “is associated with lower all-cause mortality and MACE compared to medical therapy for primary aldosteronism. For most patients, the long-term surgical benefits outweigh the short-term perioperative risks.”
- Samnani S, Cenzer I, Kline GA, Lee SJ, et. al. Time to Benefit of Surgery vs. Targeted Medical Therapy for Patients with Primary Aldosteronism: A Meta-analysis. J Clin Endocrinol Metab. 2023 Nov 8:dgad654. doi: 10.1210/clinem/dgad654. Epub ahead of print. PMID: 37946600.
