Unilateral adrenalectomy achieved a significant additional reduction in left ventricular end-diastolic diameter compared to MRA therapy (-1%; 95% CI -2% to -1%; p=0.0001).
Meta-Analysis (n=1,696)
Does unilateral adrenalectomy improve left ventricular reverse remodeling compared to MRA therapy in patients with primary aldosteronism?
Unilateral adrenalectomy achieves more complete left ventricular reverse remodeling than MRA therapy in patients with primary aldosteronism, preventing progression toward dilated cardiomyopathy.
Mean Difference: -1 (95% CI -2–-1)
Absolute Event Rate: -2.4% vs -2.1%
p-value: p=0.0001
Objective: Primary aldosteronism (PA) is a major and underdiagnosed cause of secondary hypertension, characterized by disproportionate cardiac remodeling driven by aldosterone excess. This study evaluates the differential impact of unilateral adrenalectomy (UA) versus mineralocorticoid receptor antagonist (MRA) therapy on left ventricular (LV) size and systolic recovery, integrating the most robust evidence from the Medical versus Adrenalectomy Treatment Compared in Hyperaldosteronism (MATCH) Study.1 Design and method: A systematic review and meta-analysis was conducted across MEDLINE and Embase up to November 2024, including prospective and retrospective clinical studies with >=6 months of follow-up reporting echocardiographic or cardiac MRI measures of LV structure and function in PA patients treated with UA or MRA therapy. Seventeen studies (n = 1,696; 49% UA) met eligibility criteria. Pooled analyses were performed using fixed- and random-effects models. Primary outcomes included change in LV end-diastolic diameter (LVEDD) and LV ejection fraction (LVEF). Heterogeneity and treatment interaction analyses were conducted according to predefined methodological standards. Results: At baseline, LVEDD (∼51 mm) and LVEF (∼65%) were comparable across groups. Both UA and MRA therapy significantly reduced LVEDD (-2.4 mm vs -2.1 mm). Comparative pooling, however, demonstrated a modest but significant additional LVEDD reduction with UA (-1%; 95% CI -2% to -1%; p=0.0001; I2=0%). UA also yielded a slight improvement in LVEF (+1%; 95% CI 0-1%; p<0.0001), whereas MRA therapy produced no significant systolic recovery. Despite numerically small absolute changes, the consistent treatment-related pattern across heterogeneous cohorts supports a genuine biological effect. Conclusions: UA achieves more complete LV reverse remodeling than MRA therapy and prevents progression toward dilated cardiomyopathy. These findings reinforce current guideline recommendations and provide compelling mechanistic confirmation that aldosterone excess is a central driver of pathological cardiac remodeling. Early identification and targeted suppression of aldosterone, whether through adrenalectomy, receptor blockade, or emerging aldosterone-synthesis inhibitors, represent critical strategies to optimize long-term cardiovascular outcomes in PA. 1. Marzano L, et al. Adrenalectomy Versus Medical Therapy in Primary Aldosteronism: A Meta-Analysis of Long-Term Cardiac Remodeling and Function: Medical versus Adrenalectomy Treatment Compared in Hyperaldosteronism (MATCH) Study. Hypertension 2025.
Zoccatelli et al. (Fri,) conducted a meta-analysis in Primary aldosteronism (n=1,696). Unilateral adrenalectomy (UA) vs. Mineralocorticoid receptor antagonist (MRA) therapy was evaluated on Change in LV end-diastolic diameter (LVEDD) (MD -1%, 95% CI -2 to -1, p=0.0001). Unilateral adrenalectomy achieved a significant additional reduction in left ventricular end-diastolic diameter compared to MRA therapy (-1%; 95% CI -2% to -1%; p=0.0001).