Key result
Spironolactone improves arterial stiffness comparably to adrenalectomy in primary aldosteronism at 1 year.
Why the study?
Elevated arterial stiffness in primary aldosteronism can be reversed after adrenalectomy, but the effect of medical treatment with mineralocorticoid receptor antagonists is unknown.
Does mineralocorticoid receptor antagonist therapy (spironolactone) improve arterial stiffness (pulse wave velocity) comparably to surgical adrenalectomy at 1 year in patients with primary aldosteronism?
Cohort (n=459)
No
Does mineralocorticoid receptor antagonist therapy (spironolactone) improve arterial stiffness (pulse wave velocity) comparably to surgical adrenalectomy at 1 year in patients with primary aldosteronism?
Medical therapy with spironolactone significantly reduces arterial stiffness at 1 year in patients with primary aldosteronism to a degree comparable to surgical adrenalectomy, despite adrenalectomy achieving greater reductions in blood pressure and aldosterone levels.
Answers are grounded in this paper and cite their sources.
Spironolactone was associated with arterial stiffness reduction comparable to adrenalectomy; leaves open randomized confirmation of medical versus surgical therapy in primary aldosteronism.
Background: Elevated arterial stiffness in patients with primary aldosteronism (PA) can be reversed after adrenalectomy; however, the effect of medical treatment with mineralocorticoid receptor antagonist (MRAs) is unknown. Objectives: The aim of this study was to evaluate the effect of MRAs and compare both treatment strategies on arterial stiffness in PA patients. Design: Prospective cohort study. Methods: We prospectively enrolled PA patients from 2006 to 2019 who received either adrenalectomy or MRA treatment (spironolactone). We compared their baseline and 1-year post-treatment biochemistry characteristics and arterial pulse wave velocity (PWV) to verify the effects of treatment and related determinant factors. Results: A total 459 PA patients were enrolled. After 1:1 propensity score matching for age, sex and blood pressure (BP), each group had 176 patients. The major determinant factors of baseline PWV were age and baseline BP. The adrenalectomy group had greater improvements in BP, serum potassium level, plasma aldosterone concentration, and aldosterone-to-renin ratio. The MRA group had a significant improvement in PWV after 1 year of treatment (1706.2 ± 340.05 to 1613.6 ± 349.51 cm/s, p < 0.001). There were no significant differences in post-treatment PWV ( p = 0.173) and improvement in PWV ( p = 0.579) between the adrenalectomy and MRA groups. The determinant factors for an improvement in PWV after treatment were hypertension duration, baseline PWV, and the decrease in BP. Conclusion: The PA patients who received medical treatment with MRAs had a significant improvement in arterial stiffness. There was no significant difference in the improvement in arterial stiffness between the two treatment strategies.
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Liao et al. (2023) conducted a cohort in Primary aldosteronism (n=459). Mineralocorticoid receptor antagonist (spironolactone) vs. Adrenalectomy was evaluated on Change in brachial-ankle pulse wave velocity (ΔPWV, cm/s) at 1 year (β -13.72, 95% CI -62.36 to 34.91, p=0.579). Spironolactone significantly improved arterial stiffness over 1 year in primary aldosteronism (PWV 1706.2 to 1613.6 cm/s, p<0.001), with no significant difference vs adrenalectomy (p=0.579).
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