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. 2024 Nov 1;110(11):7367-7380.
doi: 10.1097/JS9.0000000000002048.

Cardiovascular and all-cause mortality outcomes of adrenalectomy versus medical treatment in primary aldosteronism: an umbrella review

Sandeep S Nayak  1 , Ehsan Amini-Salehi  2 , Farahnaz Joukar  2 , Pubali Biswas  3 , Sara Nobakht  2 , Negin Letafatkar  4 , Parham Porteghali  5 , Erfan Mohammadi-Vajari  6 , Fariborz Mansour-Ghanaei  2 , Mona Javid  2 , Arian Mirdamadi  2 , Daniyal Ameen  1 , Behrang Motamed  5 , Soheil Hassanipour  2 , Mohammad-Hossein Keivanlou  2   4
Affiliations

Cardiovascular and all-cause mortality outcomes of adrenalectomy versus medical treatment in primary aldosteronism: an umbrella review

Sandeep S Nayak et al. Int J Surg. .

Abstract

Background: Primary aldosteronism (PA) is now recognized as the most prevalent form of secondary hypertension globally, contributing significantly to cardiovascular morbidity and mortality. This umbrella review aims to systematically compare cardiovascular outcomes and all-cause mortality in PA patients undergoing adrenalectomy versus mineralocorticoid receptor antagonist (MRA) treatment, aiming to inform optimal management strategies.

Method: Following PRISMA guidelines (Supplemental Digital Content 1, http://links.lww.com/JS9/D386 ) (Supplemental Digital Content 2, http://links.lww.com/JS9/D387 ), a comprehensive search strategy was employed across multiple databases. Meta-analyses focusing on cardiovascular outcomes or all-cause mortality, comparing adrenalectomy and MRAs treatment in PA patients, were included. Studies were independently screened and assessed for quality using AMSTAR 2 (Supplemental Digital Content 3, http://links.lww.com/JS9/D388 ) and GRADE checklists.

Results: A total of eight studies met the inclusion criteria. Adrenalectomy showed potential benefits over MRAs in reducing the risk of arrhythmias (OR=2.17; 95% CI: 1.25-3.76) and major adverse cardiovascular events (OR=1.81; 95% CI: 1.33-2.46). Patients treated with MRAs exhibited a higher risk of cardiovascular events (OR=1.23; 95% CI: 1.05-1.44), hypertension (OR=3.22; 95% CI: 1.15-8.97), and all-cause mortality (OR=3.03; 95% CI: 1.36-6.70) compared to adrenalectomy.

Conclusion: Adrenalectomy appears to offer favorable outcomes compared to MRAs treatment in PA patients, particularly in reducing the risk of major adverse cardiovascular events and all-cause mortality. These findings suggest the importance of considering surgical intervention as a primary treatment modality for PA.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Graphical abstract
Figure 1
Figure 1
The bibliometric network map depicts keyword prevalence in scientific articles on primary aldosteronism (PA) management from 2005 up to now. Bubble size represents publication frequency, while interconnections show topic relationships. The color gradient, from purple to yellow, reflects chronological evolution. Notably, keywords such as adrenal vein sampling (AVS) and surgical treatment have received significant research attention. This figure was generated using VOS viewer (version 1.6.20, www.vosviewer.com) with data from the PubMed database.
Figure 2
Figure 2
Flowchart of the study selection process
Figure 3
Figure 3
Result of quality assessment according to AMSTAR 2 checklist.
Figure 4
Figure 4
Result of power analysis. A: atrial fibrillation, B: cardiovascular events, C: left ventricular mass change, D: systolic blood pressure, E: antihypertensive agent, F: major adverse cardiovascular events, G: stroke, H: myocardial infarction, I: coronary artery disease, J: hypertension, K: congestive heart failure, L: arrhythmias and M: all-cause mortality.
Figure 5
Figure 5
Comparison of cardiovascular outcomes and all-cause mortality between mineralocorticoid receptor antagonist (MRA) treatment and adrenalectomy in patients with primary aldosteronism (PA).
Figure 6
Figure 6
Potential mechanism of action underlying cardiovascular outcomes associated with mineralocorticoid receptor antagonists (MRAs) in patients with primary aldosteronism (PA), highlighting the superiority of adrenalectomy
See this image and copyright information in PMC

References

    1. Vaidya A, Hundemer GL, Nanba K, et al. . Primary aldosteronism: state-of-the-art review. Am J Hypertens 2022;35:967–988. - PMC - PubMed
    1. Conn JW, Louis LH. Primary aldosteronism, a new clinical entity. Ann Intern Med 1956;44:1–15. - PubMed
    1. Byrd JB, Turcu AF, Auchus RJ. Primary aldosteronism: practical approach to diagnosis and management. Circulation 2018;138:823–835. - PMC - PubMed
    1. Rimoldi SF, Scherrer U, Messerli FH. Secondary arterial hypertension: when, who, and how to screen? Eur Heart J 2014;35:1245–1254. - PubMed
    1. Funder JW, Carey RM, Mantero F, et al. . The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2016;101:1889–1916. - PubMed

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