Adrenalectomy did not significantly differ from mineralocorticoid receptor antagonists in reducing left ventricular mass in primary aldosteronism (SMD 0.130; 95% CI -0.085 to 0.345; P=0.24).
Meta-Analysis (n=355)
Does unilateral adrenalectomy reduce left ventricular mass compared to mineralocorticoid receptor antagonists in patients with primary aldosteronism?
Surgical and medical treatments are comparably effective in reducing left ventricular mass in patients with primary aldosteronism, despite surgery having a greater effect on blood pressure.
Standardized Mean Difference: 0.13 (95% CI -0.085–0.345)
p-value: p=0.24
BACKGROUND: Primary aldosteronism (PA) is associated with an increase in left ventricular (LV) mass beyond the amount needed to compensate the hypertension-related workload. Available evidence suggests effectiveness of surgical treatment of PA in decreasing LV mass, whereas data on medical treatment are controversial. We have conducted a meta-analysis of long-term follow-up studies on surgical and medical treatment of PA to compare the effects of treatments on LV mass. METHODS: Medline and Cochrane searches were performed including the following words: hyperaldosteronism, left ventricular mass, mineralocorticoid receptor antagonists, surgery, adrenalectomy, and follow-up studies. Studies published within 2013 focusing on cardiac effects of treatment and follow-up longer than 6 months were selected. Data extraction was performed independently by 2 authors. RESULTS: Of 61 retrieved articles, 4 were included in the analysis. These studies enrolled 355 patients with PA who had an average follow-up of 4.0 years after unilateral adrenalectomy (n = 178) or treatment with mineralocorticoid receptor antagonists (n = 177). Despite greater effect of surgery over medical treatment in reducing blood pressure, meta-analysis of the selected studies demonstrated no significant difference in LV mass change between patients with PA who were treated with mineralocorticoid receptor antagonists or adrenalectomy (standard mean difference = 0.130; 95% confidence interval = -0.085 to 0.345; P = 0.24; I2 = 0%). CONCLUSIONS: Available evidence indicates that reduction of LV mass is not different in PA patients treated with adrenalectomy or mineralocorticoid receptor antagonists.
Marzano et al. (Tue,) conducted a meta-analysis in Primary aldosteronism (n=355). Adrenalectomy vs. Mineralocorticoid receptor antagonists was evaluated on Left ventricular mass change (SMD 0.130, 95% CI -0.085 to 0.345, p=0.24). Adrenalectomy did not significantly differ from mineralocorticoid receptor antagonists in reducing left ventricular mass in primary aldosteronism (SMD 0.130; 95% CI -0.085 to 0.345; P=0.24).