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