Medical management of primary hyperaldosteronism yielded comparable cardiovascular outcomes to adrenalectomy (P>0.19); higher potassium levels reduced incident arrhythmia (HR 0.49; 95% CI 0.24-1.00).
Cohort (n=1,001)
Yes
Does medical management result in comparable cardiovascular outcomes to surgical management in patients with primary hyperaldosteronism?
Adequate medical management of primary hyperaldosteronism, with avoidance of hypokalemia, is associated with cardiovascular outcomes comparable to those of surgical adrenalectomy.
p-value: p=>0.19
Objective: Primary hyperaldosteronism (PA), once considered as rare cause of hypertension, is a leading cause of secondary hypertension. When compared to essential hypertension, PA is associated with high rates of cardiovascular diseases and all-cause mortality. Despite the recent advances in PA research, the optimal therapy of choice remains unknown. Some observational studies from single clinics and with short follow-ups have suggested that adrenalectomy may lead to lower all-cause mortality compared to medical management. However, the long-term outcomes of medical versus surgical management in a nationwide patient sample with extended follow-up remain unclear. Design and method: We used data from the FinnGen register-based database that includes nationwide information on diagnoses, procedures, and laboratory values over several decades from 52021 individuals. We identified 1001 participants with a PA diagnosis who were divided into two subgroups: PA without (N=823) and with (N=178) adrenalectomy. We assessed the association between therapy of choice with three adverse outcomes (cardiovascular disease, major adverse cardiovascular events, and arrythmia) using multivariable-adjusted Cox models. We also examined the links between mean post-diagnosis potassium levels and adverse events in a subgroup with potassium data available (N=606). Results: Therapy of choice was not associated with any of the adverse outcomes in the age- and sex-adjusted (P>0.12 for all) or the multivariable-adjusted (P>0.19 for all) analyses (Figure). However, we observed a significant multivariable-adjusted association between potassium levels and incident arrhythmia in the medical therapy group (HR per 1 mmol increase in potassium 0.49; 95% CI 0.24-1.00; P=0.049) and in the whole study sample (HR 0.52; 95% CI 0.28-0.97; P=0.038). Conclusions: Our findings indicate that adequate medical management of PA, with avoidance of hypokalemia, leads to outcomes comparable to those of surgery.
Heinonen et al. (Fri,) conducted a cohort in Primary hyperaldosteronism (n=1,001). Medical management vs. Adrenalectomy was evaluated on Cardiovascular disease, major adverse cardiovascular events, and arrythmia (p=>0.19). Medical management of primary hyperaldosteronism yielded comparable cardiovascular outcomes to adrenalectomy (P>0.19); higher potassium levels reduced incident arrhythmia (HR 0.49; 95% CI 0.24-1.00).