Long-term mortality and cardiovascular events in patients with unilateral primary aldosteronism after targeted treatments. Issue 2 (20th December 2021)

• Record Type: Journal Article
• Authors: Wu, Vin-Cent; Wang, Shuo-Meng; Huang, Kuo-How; Tsai, Yao Chou; Chan, Chieh-Kai; Yang, Shao-Yu; Lin, Lian-Yu; Chang, Chin-Chen; Lu, Ching-Chu; Lin, Yen-Hung; Chen, Yung-Ming; Chueh, Jeff S
• Is Part Of: European journal of endocrinology. Volume 186:Issue 2(2022)
• Page Start: 195
• Page End: 205
• Publication Date: 2021-12-20
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1530/EJE-21-0836
• Languages: English
• ISSNs: 0804-4643

Abstract

Abstract: Objective: Long-term outcomes (especially mortality and/or major cardiovascular events (MACE)) of the unilateral primary aldosteronism (uPA) patients who underwent medical or surgery-targeted treatment, relative to those with essential hypertension (EH), have been scarcely reported. Design and settings: Using the prospectively designed observational Taiwan Primary Aldosteronism Investigation cohort, we identified 858 uPA cases among 1220 primary aldosteronism patients and another 1210 EH controls. Exposures: Operated uPA patients were grouped via their 1-year post-therapy statuses. Results: Primary Aldosteronism Surgical Outcome clinical complete success (hypertension remission) was achieved in 272 (49.9%) of 545 surgically treated uPA patients. After follow-up for 6.3 ± 4.0 years, both hypertension-remissive (hazard ratio (HR): 0.54; P < 0.001) and not-cured (HR: 0.61; P < 0.001) uPA patients showed a lower risk of all-cause mortality than that of EH controls; whereas the not-cured group had a higher risk of incident MACE (sub-hazard ratio (sHR), 1.41; P = 0.037) but similar atrial fibrillation (Af) and congestive heart failure (CHF). Mineralocorticoid receptor antagonist (MRA)-treated uPA patients had higher risks of MACE (sHR: 1.38; P = 0.033), Af (sHR:1.62, P = 0.049), and CHF (sHR: 1.44; P = 0.048) than those of EH controls, with mortality as a competing risk. Using inverse probability of treatment-weighted matching and counting adrenalectomy as a time-varying factor, treatment with adrenalectomy was associated with lower risks of all-cause mortality (HR: 0.57; P = 0.035), MACE (HR: 0.67; P = 0.037), and CHF (HR: 0.49; P = 0.005) compared to those of MRA therapy. Conclusions: Adrenalectomy, independent of post-surgical hypertension remission, was associated with lower all-cause mortality of uPA patients, compared to that of EH patients. We further documented a more beneficial effect of adrenalectomy over MRA treatment on long-term mortality, MACE, and CHF in uPA patients.