Key result
MRA treatment linked to ~183% higher new-onset AF risk versus adrenalectomy in primary aldosteronism.
Why the study?
Primary aldosteronism is linked to an increased risk of new-onset atrial fibrillation, but the relative effects of surgical versus medical therapies on preventing it remain unclear.
Does MRA treatment compared to adrenalectomy increase the risk of new-onset atrial fibrillation in patients with primary aldosteronism?
Meta-Analysis (n=52,499)
Does MRA treatment compared to adrenalectomy increase the risk of new-onset atrial fibrillation in patients with primary aldosteronism?
Effect estimate: OR 2.83 (95% CI 1.76-4.57)
Medical therapy with MRAs for primary aldosteronism is associated with a higher risk of new-onset atrial fibrillation compared to surgical adrenalectomy.
May favor adrenalectomy over MRAs to reduce atrial fibrillation risk in primary aldosteronism; leaves open need for randomized confirmation.
Background Primary aldosteronism (PA) is a common cause of secondary hypertension and associated with higher incidence of new-onset atrial fibrillation (NOAF). However, the effects of surgical or medical therapies on preventing NOAF in PA patents remain unclear. The aim of this meta-analysis study was to assess the risk of NOAF among PA patients receiving mineralocorticoid receptor antagonist (MRA) treatment, PA patients receiving adrenalectomy, and patients with essential hypertension. Methods We performed the meta-analysis of the randomized or observational studies that investigated the incidence rate of NOAF in PA patients receiving MRA treatment versus PA patients receiving adrenalectomy from database inception until December 01, 2020 which were identified from PubMed, Embase, and Cochrane Library. Results A total of 172 related studies were reviewed, of which three fulfilled the inclusion criteria, including a total of 2,705 PA patients. The results of meta-analysis demonstrated a higher incidence of NOAF among the PA patients receiving MRA treatment compared to the PA patients receiving adrenalectomy (pooled odds ratio [OR]: 2.83, 95% confidence interval [CI]: 1.76–4.57 in the random effects model, I 2 = 0%). The pooled OR for the PA patients receiving MRA treatment compared to the patients with essential hypertension was 1.91 (95% CI: 1.11–3.28). The pooled OR for the PA patients receiving adrenalectomy compared to the patients with essential hypertension was 0.70 (95% CI: 0.28–1.79). Conclusion Compared to the essential hypertension patients and the PA patients receiving adrenalectomy, the patients with PA receiving MRA treatment had a higher risk of NOAF. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42021222022.
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Tsai et al. (2021) conducted a meta-analysis in Primary aldosteronism (n=52,499). Mineralocorticoid receptor antagonist (MRA) treatment vs. Adrenalectomy was evaluated on Incidence of new-onset atrial fibrillation (NOAF) (OR 2.83, 95% CI 1.76-4.57). Mineralocorticoid receptor antagonist treatment in patients with primary aldosteronism was associated with a significantly higher risk of new-onset atrial fibrillation compared to adrenalectomy (OR 2.83).
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