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11-03-2022 | Hyperaldosteronism | Original Article

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

Authors: Marta Araujo-Castro, Miguel Paja Fano, Marga González Boillos, Begoña Pla Peris, Eider Pascual-Corrales, Ana María García Cano, Paola Parra Ramírez, Patricia Martín Rojas-Marcos, Jorge Gabriel Ruiz-Sanchez, Almudena Vicente Delgado, Emilia Gómez Hoyos, Rui Ferreira, Iñigo García Sanz, Patricia Díaz Guardiola, Juan Jesús García González, Carolina M. Perdomo, Manuel Morales, Felicia A. Hanzu

Published in: Endocrine | Issue 3/2022

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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Title: Evolution of the cardiometabolic profile of primary hyperaldosteronism patients treated with adrenalectomy and with mineralocorticoid receptor antagonists: results from the SPAIN-ALDO Registry
Authors: Marta Araujo-Castro
Miguel Paja Fano
Marga González Boillos
Begoña Pla Peris
Eider Pascual-Corrales
Ana María García Cano
Paola Parra Ramírez
Patricia Martín Rojas-Marcos
Jorge Gabriel Ruiz-Sanchez
Almudena Vicente Delgado
Emilia Gómez Hoyos
Rui Ferreira
Iñigo García Sanz
Patricia Díaz Guardiola
Juan Jesús García González
Carolina M. Perdomo
Manuel Morales
Felicia A. Hanzu
Publication date: 11-03-2022
Publisher: Springer US
Keywords: Hyperaldosteronism
Adrenalectomy
Hypertension
Adrenalectomy
Hypertension
Published in: Endocrine / Issue 3/2022
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-022-03029-4

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