Evolution of the cardiometabolic profile of primary hyperaldosteronism patients treated with adrenalectomy and with mineralocorticoid receptor antagonists: results from the SPAIN-ALDO Registr
Marta Araujo-Castro 1 2 3 , Miguel Paja Fano 4 , Marga González Boillos 5 , Begoña Pla Peris 5 , Eider Pascual-Corrales 6 7 , Ana María García Cano 8 , Paola Parra Ramírez 9 , Patricia Martín Rojas-Marcos 9 , Jorge Gabriel Ruiz-Sanchez 10 , Almudena Vicente Delgado 11 , Emilia Gómez Hoyos 12 , Rui Ferreira 13 , Iñigo García Sanz 14 , Patricia Díaz Guardiola 15 , Juan Jesús García González 16 , Carolina M Perdomo 17 , Manuel Morales 18 , Felicia A Hanzu 19
Objective: To analyze the evolution of the cardiometabolic profile of patients with primary hyperaldosteronism (PA) after the treatment with surgery and with mineralocorticoid receptor antagonists (MRA).
Design: Retrospective multicentric study of patients with PA on follow-up in twelve Spanish centers between 2018 and 2020.
Results: 268 patients with PA treated by surgery (n = 100) or with MRA (n = 168) were included. At baseline, patients treated with surgery were more commonly women (54.6% vs 41.7%, P = 0.042), had a higher prevalence of hypokalemia (72.2% vs 58%, P = 0.022) and lower prevalence of obesity (37.4% vs 51.3%, P = 0.034) than patients treated with MRA.
Adrenalectomy resulted in complete biochemical cure in 94.0% and clinical response in 83.0% (complete response in 41.0% and partial response in 42.0%). After a median follow-up of 23.6 (IQR 9.7-53.8) months, the reduction in blood pressure (BP) after treatment was similar between the group of surgery and MRA, but patients surgically treated reduced the number of antihypertensive pills for BP control more than those medically treated (∆antihypertensives: -1.3 ± 1.3 vs 0.0 ± 1.4, P < 0.0001) and experienced a higher increased in serum potassium levels (∆serum potassium: 0.9 ± 0.7 vs 0.6 ± 0.8mEq/ml, P = 0.003). However, no differences in the risk of the onset of new renal and cardiometabolic comorbidities was observed between the group of surgery and MRA (HR = 0.9 [0.5-1.5], P = 0.659).
Conclusion: In patients with PA, MRA and surgery offer a similar short-term cardiovascular protection, but surgery improves biochemical control and reduces pill burden more commonly than MRA, and lead to hypertension cure or improvement in up to 83% of the patients.