Incidental Congestive Heart Failure in Patients With Aldosterone-Producing Adenomas

Abstract

Background Previous studies show that patients with primary aldosteronism are associated with higher risk of congestive heart failure (CHF). However, the effect of target treatment to the incidental CHF has not been elucidated. We aimed to investigate the risk of new-onset CHF in patients with aldosterone-producing adenomas (APAs) and explore the effect of adrenalectomy on new onset of CHF. Methods and Results From 1997 to 2009, 688 APA were identified and matched with essential hypertension controls. The risks of developing incidental CHF (hazard ratio, 0.49; 95% CI, 0.31-0.75; P=0.001) and mortality (hazard ratio, 0.29; 95% CI, 0.20-0.44; P<0.001) were significantly lower in the APA group after targeted treatment. A total of 605 patients with APAs who underwent adrenalectomy lowered the risks of CHF (subdistribution hazard ratio, 0.55; 95% CI, 0.34-0.90; P=0.017) and mortality (adjusted hazard ratio, 0.27; 95% CI, 0.16-0.44; P<0.001) compared with essential hypertension controls. Conclusions In conclusion, for patients with APAs, adrenalectomy can be associated with lower risk of incidental CHF and all-cause mortality in a long-term follow-up.

Keywords: adrenalectomy; aldosterone‐producing adenomas; cardiovascular disease; congestive heart failure; essential hypertension; primary aldosteronism.

Figure 1

Flow diagram of selecting study subjects. Our study enrolled patients with PA, which was diagnosed by combining ICD‐9‐CM 255.1 and use of MRA 1 year before and after the diagnosis. We also excluded patients with documented congestive heart failure (CHF). APA indicates aldosterone‐producing adenoma; IHA, Idiopathic bilateral hyperaldosteronism; MRA, mineralocorticoid receptor antagonist; PA, primary aldosteronism.