Back to Search
Start Over
Long-term mortality and cardiovascular events in patients with unilateral primary aldosteronism after targeted treatments.
- Source :
-
European journal of endocrinology [Eur J Endocrinol] 2021 Dec 20; Vol. 186 (2), pp. 195-205. Date of Electronic Publication: 2021 Dec 20. - Publication Year :
- 2021
-
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.<br />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.<br />Exposures: Operated uPA patients were grouped via their 1-year post-therapy statuses.<br />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.<br />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.
- Subjects :
- Adrenalectomy trends
Adult
Aged
Cardiovascular Diseases diagnosis
Cohort Studies
Drug Delivery Systems trends
Essential Hypertension diagnosis
Essential Hypertension mortality
Essential Hypertension therapy
Female
Humans
Hyperaldosteronism diagnosis
Male
Middle Aged
Mortality trends
Prospective Studies
Taiwan epidemiology
Treatment Outcome
Adrenalectomy mortality
Cardiovascular Diseases mortality
Drug Delivery Systems mortality
Hyperaldosteronism mortality
Hyperaldosteronism therapy
Mineralocorticoid Receptor Antagonists administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1479-683X
- Volume :
- 186
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- European journal of endocrinology
- Publication Type :
- Academic Journal
- Accession number :
- 34851859
- Full Text :
- https://doi.org/10.1530/EJE-21-0836