Marta Araujo-Castro1,2,3, Miguel Paja Fano4, Marga González Boillos5, Begoña Pla Peris5, Eider Pascual-Corrales6,7, Ana María García Cano8, Paola Parra Ramírez9, Patricia Martín Rojas-Marcos9, Jorge Gabriel Ruiz-Sanchez10, Almudena Vicente Delgado11, Emilia Gómez Hoyos12, Rui Ferreira13, Iñigo García Sanz14, Patricia Díaz Guardiola15, Juan Jesús García González16, Carolina M Perdomo17, Manuel Morales18, Felicia A Hanzu19. 1. Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. marta.araujo@salud.madrid.org. 2. Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain. marta.araujo@salud.madrid.org. 3. University of Alcalá, Madrid, Spain. marta.araujo@salud.madrid.org. 4. Endocrinology & Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain. 5. Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain. 6. Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. 7. Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain. 8. Biochemistry Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. 9. Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain. 10. Endocrinology & Nutrition Department, Hospital Fundación Jiménez Díaz, Madrid, Spain. 11. Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo, Spain. 12. Endocrinology & Nutrition Department, Hospital Universitario de Valladolid, Valladolid, Spain. 13. Endocrinology & Nutrition Department, Hospital Universitario de La Princesa, Madrid, Spain. 14. General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain. 15. Endocrinology & Nutrition Department, Hospital Universitario Infanta Sofía, Madrid, Spain. 16. Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain. 17. Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain. 18. Biochemistry Department, Hospital Clinic, Barcelona, Spain. 19. Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain.
Abstract
OBJECTIVE: To analyze the evolution of the cardiometabolic profile of patients with primary hyperaldosteronism (PA) after the treatment with surgery and with mineralocorticoid receptor antagonists (MRA). DESIGN: Retrospective multicentric study of patients with PA on follow-up in twelve Spanish centers between 2018 and 2020. RESULTS: 268 patients with PA treated by surgery (n = 100) or with MRA (n = 168) were included. At baseline, patients treated with surgery were more commonly women (54.6% vs 41.7%, P = 0.042), had a higher prevalence of hypokalemia (72.2% vs 58%, P = 0.022) and lower prevalence of obesity (37.4% vs 51.3%, P = 0.034) than patients treated with MRA. Adrenalectomy resulted in complete biochemical cure in 94.0% and clinical response in 83.0% (complete response in 41.0% and partial response in 42.0%). After a median follow-up of 23.6 (IQR 9.7-53.8) months, the reduction in blood pressure (BP) after treatment was similar between the group of surgery and MRA, but patients surgically treated reduced the number of antihypertensive pills for BP control more than those medically treated (∆antihypertensives: -1.3 ± 1.3 vs 0.0 ± 1.4, P < 0.0001) and experienced a higher increased in serum potassium levels (∆serum potassium: 0.9 ± 0.7 vs 0.6 ± 0.8mEq/ml, P = 0.003). However, no differences in the risk of the onset of new renal and cardiometabolic comorbidities was observed between the group of surgery and MRA (HR = 0.9 [0.5-1.5], P = 0.659). CONCLUSION: In patients with PA, MRA and surgery offer a similar short-term cardiovascular protection, but surgery improves biochemical control and reduces pill burden more commonly than MRA, and lead to hypertension cure or improvement in up to 83% of the patients.
OBJECTIVE: To analyze the evolution of the cardiometabolic profile of patients with primary hyperaldosteronism (PA) after the treatment with surgery and with mineralocorticoid receptor antagonists (MRA). DESIGN: Retrospective multicentric study of patients with PA on follow-up in twelve Spanish centers between 2018 and 2020. RESULTS: 268 patients with PA treated by surgery (n = 100) or with MRA (n = 168) were included. At baseline, patients treated with surgery were more commonly women (54.6% vs 41.7%, P = 0.042), had a higher prevalence of hypokalemia (72.2% vs 58%, P = 0.022) and lower prevalence of obesity (37.4% vs 51.3%, P = 0.034) than patients treated with MRA. Adrenalectomy resulted in complete biochemical cure in 94.0% and clinical response in 83.0% (complete response in 41.0% and partial response in 42.0%). After a median follow-up of 23.6 (IQR 9.7-53.8) months, the reduction in blood pressure (BP) after treatment was similar between the group of surgery and MRA, but patients surgically treated reduced the number of antihypertensive pills for BP control more than those medically treated (∆antihypertensives: -1.3 ± 1.3 vs 0.0 ± 1.4, P < 0.0001) and experienced a higher increased in serum potassium levels (∆serum potassium: 0.9 ± 0.7 vs 0.6 ± 0.8mEq/ml, P = 0.003). However, no differences in the risk of the onset of new renal and cardiometabolic comorbidities was observed between the group of surgery and MRA (HR = 0.9 [0.5-1.5], P = 0.659). CONCLUSION: In patients with PA, MRA and surgery offer a similar short-term cardiovascular protection, but surgery improves biochemical control and reduces pill burden more commonly than MRA, and lead to hypertension cure or improvement in up to 83% of the patients.
Authors: Paul Milliez; Xavier Girerd; Pierre-François Plouin; Jacques Blacher; Michel E Safar; Jean-Jacques Mourad Journal: J Am Coll Cardiol Date: 2005-04-19 Impact factor: 24.094