Long-term Mortality and Cardiovascular Events in Patients with Unilateral Primary Aldosteronism after Targeted Treatments

in European Journal of Endocrinology
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  • 1 V Wu, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
  • | 2 S Wang, Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
  • | 3 K Huang, Department of Urology, National Taiwan University Hospital, Taipei, 100, Taiwan
  • | 4 Y Tsai, Department of Urology, Taipei Medical University, Taipei, 110, Taiwan
  • | 5 C Chan, Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • | 6 S Yang, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
  • | 7 L Lin, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
  • | 8 C Chang, Department of Imaging Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
  • | 9 C Lu, Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
  • | 10 Y Lin, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • | 11 Y Chen, Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  • | 12 J Chueh, Urology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, United States

Correspondence: Jeff Chueh, Email: jeffchueh@gmail.com
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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 TAIPAI cohort, we identified 858 uPA cases among 1220 primary aldosteronism (PA) patients and another 1210 EH controls.

EXPOSURES

Operated uPA patients were grouped via their 1-year post-therapy statuses.

RESULTS

PASO 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 (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.

 

     European Society of Endocrinology