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Evolution of the cardiometabolic profile of primary hyperaldosteronism patients treated with adrenalectomy and with mineralocorticoid receptor antagonists: results from the SPAIN-ALDO Registry

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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.

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References

  1. G.P. Rossi, G. Bernini, C. Caliumi, G. Desideri, B. Fabris, C. Ferri et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J. Am. Coll. Cardiol. 48, 2293–2300 (2006) https://doi.org/10.1016/j.jacc.2006.07.059

    Article  CAS  PubMed  Google Scholar 

  2. P. Milliez, X. Girerd, P.F. Plouin, J. Blacher, M.E. Safar, J.J. Mourad et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J. Am. Coll. Cardiol. 45, 1243–1248 (2005) https://doi.org/10.1016/j.jacc.2005.01.015

    Article  CAS  PubMed  Google Scholar 

  3. G.P. Rossi, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti et al. Renal damage in primary aldosteronism: results of the PAPY study. Hypertension 48, 232–238 (2006) https://doi.org/10.1161/01.HYP.0000230444.01215.6a

    Article  CAS  PubMed  Google Scholar 

  4. C. Catena, G. Colussi, R. Lapenna, E. Nadalini, A. Chiuch, P. Gianfagna et al. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension 50, 911–918 (2007). https://doi.org/10.1161/HYPERTENSIONAHA.107.095448

    Article  CAS  PubMed  Google Scholar 

  5. M. Fernández-Argüeso, E. Pascual-Corrales, N. Bengoa Rojano, A. García Cano, L. Jiménez Mendiguchía, M. Araujo-Castro, Higher risk of chronic kidney disease and progressive kidney function impairment in primary aldosteronism than in essential hypertension. Case-control study. Endocrine 73, 439–446 (2021). https://doi.org/10.1007/s12020-021-02704-2

    Article  CAS  PubMed  Google Scholar 

  6. S. Monticone, F. D’Ascenzo, C. Moretti, T.A. Williams, F. Veglio, F. Gaita et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 6, 41–50 (2018). https://doi.org/10.1016/S2213-8587(17)30319-4

    Article  CAS  PubMed  Google Scholar 

  7. G.L. Hundemer, G.C. Curhan, N. Yozamp, M. Wang, A. Vaidya, Incidence of atrial fibrillation and mineralocorticoid receptor activity in patients with medically and surgically treated primary aldosteronism. JAMA Cardiol. 3, 768–774 (2018). https://doi.org/10.1001/jamacardio.2018.2003

    Article  PubMed  PubMed Central  Google Scholar 

  8. C.T. Pan, C.W. Liao, C.H.T sai, Z.W. Chen, L. Chen, C.S. Hung et al. Influence of different treatment strategies on new-onset atrial fibrillation among patients with primary aldosteronism: a nationwide longitudinal cohort-based study. J. Am. Heart Assoc. 9 (2020). https://doi.org/10.1161/JAHA.119.013699

  9. G.P. Rossi, G. Maiolino, A. Flego, A. Belfiore, G. Bernini, B. Fabris et al. Adrenalectomy lowers incident atrial fibrillation in primary aldosteronism patients at long term. Hypertension 71, 585–591 (2018). https://doi.org/10.1161/hypertensionaha.117.10596

    Article  CAS  PubMed  Google Scholar 

  10. A.H. Ahmed, R.D. Gordon, N. Sukor, E. Pimenta, M. Stowasser, Quality of life in patients with bilateral primary aldosteronism before and during treatment with spironolactone and/or amiloride, including a comparison with our previously published results in those with unilateral disease treated surgically. J. Clin. Endocrinol. Metab. 96, 2904–2911 (2011). https://doi.org/10.1210/jc.2011-0138

    Article  CAS  PubMed  Google Scholar 

  11. G.L. Hundemer, G.C. Curhan, N. Yozamp, M. Wang, A. Vaidya, H. GL et al. Renal outcomes in medically and surgically treated primary aldosteronism. Hypertension 72, 658–666 (2018). https://doi.org/10.1161/HYPERTENSIONAHA.118.11568

    Article  CAS  PubMed  Google Scholar 

  12. Y. Jing, K. Liao, R. Li, S. Yang, Y. Song, W. He et al. Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: a Meta-analysis. J Renin-Angiotensin-Aldosterone Syst. 22, (2021). https://doi.org/10.1177/14703203211003781

  13. C. Catena, G.L. Colussi, E. Nadalini, A. Chiuch, S. Baroselli, R. Lapenna et al. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch. Intern. Med. 168, 80–85 (2008). https://doi.org/10.1001/archinternmed.2007.33

    Article  CAS  PubMed  Google Scholar 

  14. T.H. Puar, L.M. Loh, W.J. Loh, D.S.T. Lim, M. Zhang, P.T. Tan et al. Outcomes in unilateral primary aldosteronism after surgical or medical therapy. Clin. Endocrinol. 94, 158–167 (2021). https://doi.org/10.1111/cen.14351

    Article  Google Scholar 

  15. C. Catena, R. Lapenna, S. Baroselli, E. Nadalini, G.L. Colussi, M. Novello et al. Insulin sensitivity in patients with primary aldosteronism: a follow-up study. J. Clin. Endocrinol. Metab. (2006). https://doi.org/10.1210/jc.2006-0736

  16. L.A. Sechi, A.D.I. Fabio, M. Bazzocchi, A. Uzzau, C. Catena, Intrarenal hemodynamics in primary aldosteronism before and after treatment. J. Clin. Endocrinol. Metab. 94, 1191–1197 (2009). https://doi.org/10.1210/jc.2008-2245

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. B. Williams, G. Mancia, W. Spiering, E.A. Rosei, M. Azizi, M. Burnier et al. 2018 ESC/ESHGuidelines for themanagement of arterial hypertension. J. Hypertens. 36, 1956–2041 (2018). https://doi.org/10.1097/HJH.0000000000001940

    Article  CAS  Google Scholar 

  18. A.S. Levey, J. Coresh, K. Bolton, B. Culleton, K.S. Harvey, T.A. Ikizler et al. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am. J. Kidney Dis. 39, 3–10 (2002).

    Article  Google Scholar 

  19. J.W. Funder, R.M. Carey, F. Mantero, M.H. Murad, M. Reincke, H. Shibata et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101, 1889–1916 (2016). https://doi.org/10.1210/jc.2015-4061

    Article  CAS  PubMed  Google Scholar 

  20. P. Mulatero, S. Monticone, J. Deinum, L. Amar, A. Prejbisz, M.C. Zennaro et al. Genetics, prevalence, screening and confirmation of primary aldosteronism: a position statement and consensus of the Working Group on Endocrine Hypertension of The European Society of Hypertension. J. Hypertens. 38, 1919–1928 (2020). https://doi.org/10.1097/HJH.0000000000002510

    Article  CAS  PubMed  Google Scholar 

  21. T.A. Williams, J.W.M. Lenders, P. Mulatero, J. Burrello, M. Rottenkolber, C. Adolf et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 5, 689–699 (2017). https://doi.org/10.1016/S2213-8587(17)30135-3

    Article  PubMed  PubMed Central  Google Scholar 

  22. O. Picado, B.W. Whitfield, Z.F. Khan, M. Jeraq, J.C. Farrá, J.I. Lew, Long-term outcome success after operative treatment for primary aldosteronism. Surgery 169, 528–532 (2021). https://doi.org/10.1016/j.surg.2020.07.046

    Article  PubMed  Google Scholar 

  23. A.M. Sawka, J. Young, G.B. Thompson, C.S. Grant, D.R. Farley, C. Leibson et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann. Intern. Med. 135, 258–261 (2001). https://doi.org/10.7326/0003-4819-135-4-200108210-00010

    Article  CAS  PubMed  Google Scholar 

  24. E. Letavernier, S. Peyrard, L. Amar, F. Zinzindohoué, B. Fiquet, P.F. Plouin, Blood pressure outcome of adrenalectomy in patients with primary hyperaldosteronism with or without unilateral adenoma. J. Hypertens. 26, 1816–1823 (2008). https://doi.org/10.1097/HJH.0b013e3283060f0c

    Article  CAS  PubMed  Google Scholar 

  25. V.C. Wu, K.H. Huang, K.Y. Peng, Y.C.T. sai, C.H. Wu, S.M. Wang et al. Prevalence and clinical correlates of somatic mutation in aldosterone producing adenoma-Taiwanese population. Sci. Rep. 15 (2015). https://doi.org/10.1038/srep11396

  26. J.L. Benham, M. Eldoma, B. Khokhar, D.J. Roberts, D.M. Rabi, G.A. Kline, Proportion of patients with hypertension resolution following adrenalectomy for primary aldosteronism: a systematic review and meta-analysis. J. Clin. Hypertens. 18, 1205–1212 (2016). https://doi.org/10.1111/jch.12916

    Article  Google Scholar 

  27. L. Marzano, G. Colussi, L.A. Sechi, C. Catena, Adrenalectomy is comparable with medical treatment for reduction of left ventricular mass in primary aldosteronism: meta-analysis of long-term studies. Am. J. Hypertens. (2015). https://doi.org/10.1093/ajh/hpu154

  28. G.P. Rossi, M. Cesari, C. Cuspidi, G. Maiolino, M.V. Cicala, V. Bisogni et al. Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertension 62, 62–69 (2013). https://doi.org/10.1161/HYPERTENSIONAHA.113.01316

    Article  CAS  PubMed  Google Scholar 

  29. M. Satoh, T. Maruhashi, Y. Yoshida, H. Shibata, Systematic review of the clinical outcomes of mineralocorticoid receptor antagonist treatment versus adrenalectomy in patients with primary aldosteronism. Hypertens. Res. 42, 817–824 (2019). https://doi.org/10.1038/s41440-019-0244-4

    Article  CAS  PubMed  Google Scholar 

  30. B. Lechner, K. Lechner, D. Heinrich, C. Adolf, F. Holler, H. Schneider et al. Medical treatment of primary aldosteronism. Eur. J. Endocrinol. 181, R147–R153 (2019). https://doi.org/10.1530/EJE-19-0215

    Article  CAS  PubMed  Google Scholar 

  31. G.L. Hundemer, G.C. Curhan, N. Yozamp, M. Wang, A. Vaidya, Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 6, 51–59 (2018). https://doi.org/10.1016/S2213-8587(17)30367-4

    Article  PubMed  Google Scholar 

  32. A. Köhler, A.L. Sarkis, D.A. Heinrich, L. Müller, L. Handgriff, S. Deniz et al. Renin, a marker for left ventricular hypertrophy, in primary aldosteronism: a cohort study. Eur. J. Endocrinol. 185, 663–672 (2021). https://doi.org/10.1530/EJE-21-0018

    Article  PubMed  Google Scholar 

  33. Y. Tezuka, A.F. Turcu, Mineralocorticoid receptor antagonists decrease the rates of positive screening for primary aldosteronism. Endocr. Pract. 26, 1416–1424 (2020). https://doi.org/10.4158/EP-2020-0277

    Article  PubMed  PubMed Central  Google Scholar 

  34. M. Velema, T. Dekkers, A. Hermus, H. Timmers, J. Lenders, H. Groenewoud, et al. Quality of life in primary aldosteronism: a comparative effectiveness study of adrenalectomy and medical treatment. J. Clin. Endocrinol. Metab. 103, 16–24 (2018). https://doi.org/10.1210/jc.2017-01442

    Article  PubMed  Google Scholar 

  35. G. Bernini, A. Bacca, V. Carli, D. Carrara, G. Materazzi, P. Berti et al. Cardiovascular changes in patients with primary aldosteronism after surgical or medical treatment. J. Endocrinol. Investig. 35, 274–280 (2012). https://doi.org/10.3275/7611

    Article  CAS  Google Scholar 

  36. J.W. Funder, M. Reincke, Aldosterone: a cardiovascular risk factor? Biochim. Biophys. Acta—Mol. Basis Dis. 1802, 1188–1192 (2010). https://doi.org/10.1016/j.bbadis.2010.08.005

    Article  CAS  Google Scholar 

  37. N.K. Hollenberg, Aldosterone in the development and progression of renal injury. Kidney Int. 66, 1–9 (2004). https://doi.org/10.1111/j.1523-1755.2004.00701.x

    Article  CAS  PubMed  Google Scholar 

  38. B. Pitt, N. Reichek, R. Willenbrock, F. Zannad, R.A. Phillips, B. Roniker et al. Effects of eplerenone, enalapril, and eplerenone/enalapril in patients with essential hypertension and left ventricular hypertrophy: the 4e-left ventricular hypertrophy study. Circulation 108, 1831–1838 (2003). https://doi.org/10.1161/01.CIR.0000091405.00772.6E

    Article  CAS  PubMed  Google Scholar 

  39. H. Fukuta, T. Goto, K. Wakami, T. Kamiya, N. Ohte, Effects of mineralocorticoid receptor antagonists on left ventricular diastolic function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials. Heart Vessels 34, 597–606 (2019). https://doi.org/10.1007/s00380-018-1279-1

    Article  PubMed  Google Scholar 

  40. W. Arlt, K. Lang, A.J. Sitch, A.S. Dietz, Y. Rhayem, I. Bancos et al. Steroid metabolome analysis reveals prevalent glucocorticoid excess in primary aldosteronism. JCI Insight 2, (2017). https://doi.org/10.1172/JCI.INSIGHT.93136

  41. Y. Tezuka, A.F. Turcu, Real-world effectiveness of mineralocorticoid receptor antagonists in primary aldosteronism. Front. Endocrinol 21, (2021). https://doi.org/10.3389/FENDO.2021.625457

  42. M.J.E. Kempers, J.W.M. Lenders, L. Van Outheusden, G.J. Van Der Wilt, L.J.S. Kool, A.R.M.M. Hermus et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann. Intern. Med. 151, (2009). https://doi.org/10.7326/0003-4819-151-5-200909010-00007

  43. M.H. Wu, F.H. Liu, K.J. Lin, J.H. Sun, S.T. Chen, Diagnostic value of adrenal iodine-131 6-beta-iodomethyl-19-norcholesterol scintigraphy for primary aldosteronism: a retrospective study at a medical center in North Taiwan. Nucl. Med. Commun. 40, 568–575 (2019). https://doi.org/10.1097/MNM.0000000000000987

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

This research was funded by Sociedad Española de Endocrinología y Nutrición (SEEN) https://www.seen.es/portal.

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Authors and Affiliations

  1. Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Marta Araujo-Castro & Eider Pascual-Corrales

  2. Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain

    Marta Araujo-Castro & Eider Pascual-Corrales

  3. University of Alcalá, Madrid, Spain

    Marta Araujo-Castro

  4. Endocrinology & Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain

    Miguel Paja Fano

  5. Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain

    Marga González Boillos & Begoña Pla Peris

  6. Biochemistry Department, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Ana María García Cano

  7. Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain

    Paola Parra Ramírez & Patricia Martín Rojas-Marcos

  8. Endocrinology & Nutrition Department, Hospital Fundación Jiménez Díaz, Madrid, Spain

    Jorge Gabriel Ruiz-Sanchez

  9. Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo, Spain

    Almudena Vicente Delgado

  10. Endocrinology & Nutrition Department, Hospital Universitario de Valladolid, Valladolid, Spain

    Emilia Gómez Hoyos

  11. Endocrinology & Nutrition Department, Hospital Universitario de La Princesa, Madrid, Spain

    Rui Ferreira

  12. General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain

    Iñigo García Sanz

  13. Endocrinology & Nutrition Department, Hospital Universitario Infanta Sofía, Madrid, Spain

    Patricia Díaz Guardiola

  14. Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain

    Juan Jesús García González

  15. Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain

    Carolina M. Perdomo

  16. Biochemistry Department, Hospital Clinic, Barcelona, Spain

    Manuel Morales

  17. Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain

    Felicia A. Hanzu

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  1. Marta Araujo-Castro
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  2. Miguel Paja Fano
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Correspondence to Marta Araujo-Castro.

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Patient consent was waived due to the retrospective nature of the study. Only for patients who continued follow-up or prospectively included the informed consent was requested.

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The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of the Hospital Universitario Ramón y Cajal. Madrid. Spain (approval date: 10th November 2020, code: ACTA 401).

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Araujo-Castro, M., Paja Fano, M., González Boillos, M. et al. Evolution of the cardiometabolic profile of primary hyperaldosteronism patients treated with adrenalectomy and with mineralocorticoid receptor antagonists: results from the SPAIN-ALDO Registry. Endocrine 76, 687–696 (2022). https://doi.org/10.1007/s12020-022-03029-4

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