Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Feb 20;109(3):e1280-e1289.
doi: 10.1210/clinem/dgad654.

Time to Benefit of Surgery vs Targeted Medical Therapy for Patients With Primary Aldosteronism: A Meta-analysis

Sunil Samnani  1 , Irena Cenzer  2   3 , Gregory A Kline  1 , Sei J Lee  2   3 , Gregory L Hundemer  4 , Caitlin McClurg  5 , Janice L Pasieka  6 , W John Boscardin  2   7 , Paul E Ronksley  8 , Alexander A Leung  1   8
Affiliations
Meta-Analysis

Time to Benefit of Surgery vs Targeted Medical Therapy for Patients With Primary Aldosteronism: A Meta-analysis

Sunil Samnani et al. J Clin Endocrinol Metab. .

Abstract

Context: Primary aldosteronism (PA) is one of the most common causes of secondary hypertension, but the comparative outcomes of targeted treatment remain unclear.

Objective: To compare the clinical outcomes in patients treated for primary aldosteronism over time.

Methods: Medline and EMBASE were searched. Original studies reporting the incidence of mortality, major adverse cardiovascular outcomes (MACE), progression to chronic kidney disease, or diabetes following adrenalectomy vs medical therapy were selected. Two reviewers independently abstracted data and assessed study quality. Standard meta-analyses were conducted using random-effects models to estimate relative differences. Time to benefit meta-analyses were conducted by fitting Weibull survival curves to estimate absolute risk differences and pooled using random-effects models.

Results: 15 541 patients (16 studies) with PA were included. Surgery was consistently associated with an overall lower risk of death (hazard ratio [HR] 0.34, 95% CI 0.22-0.54) and MACE (HR 0.55, 95% CI 0.36-0.84) compared with medical therapy. Surgery was associated with a significantly lower risk of hospitalization for heart failure (HR 0.48 95% CI 0.34-0.70) and progression to chronic kidney disease (HR 0.62 95% CI 0.39-0.98), and nonsignificant reductions in myocardial infarction and stroke. In absolute terms, 200 patients would need to be treated with surgery instead of medical therapy to prevent 1 death after 12.3 (95% CI 3.1-48.7) months.

Conclusion: Surgery is associated with lower all-cause mortality and MACE than medical therapy for PA. For most patients, the long-term surgical benefits outweigh the short-term perioperative risks.

Keywords: hyperaldosteronism; mineralocorticoid receptor antagonist; surgery; time to treatment benefit.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Traditional meta-analyses of studies examining the association between treatment type and incidence of adverse outcomes. Comparisons were made for mortality (A) and major adverse cardiovascular outcomes (B).
Figure 2.
Figure 2.
Pooled survival curves from studies examining the association between treatment type and all-cause mortality. The difference between curves is equal to the number of deaths prevented per 100 people treated with surgery compared with medical therapy.
See this image and copyright information in PMC

References

    1. Brown JM, Siddiqui M, Calhoun DA, et al. . The unrecognized prevalence of primary aldosteronism: a cross-sectional study. Ann Intern Med. 2020;173(1):10‐20. - PMC - PubMed
    1. Catena C, Colussi G, Nadalini E, et al. . Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med. 2008;168(1):80‐85. - PubMed
    1. Reincke M, Rump LC, Quinkler M, et al. . Risk factors associated with a low glomerular filtration rate in primary aldosteronism. J Clin Endocrinol Metab. 2009;94(3):869‐875. - PubMed
    1. Monticone S, D’Ascenzo F, Moretti C, et al. . Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2018;6(1):41‐50. - PubMed
    1. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6(1):51‐59. - PMC - PubMed

Publication types