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- W3133627209 abstract "Background: Long-term outcomes (especially mortality and/or major cardiovascular events [MACE]) of the clinical aldosterone producing adenoma (cAPA) patients who underwent medical targeted therapy or adrenalectomy, relative to those with essential hypertension (EH), have been scarcely reported.Methods: Using an inception observational cohort, we examined the longitudinal outcomes for all cAPA patients diagnosed throughout 2003-2017. We identified 858 cAPA cases among 1220 primary aldosteronism (PA) patients and another 1210 EH controls. cAPA patients underwent unilateral adrenalectomy or mineralocorticoid receptor antagonist (MRA) therapy as opposed to standard medical treatment for EH. Operated cAPA patients were grouped via their 1-year post-therapy statuses according to the Primary Aldosteronism Surgical Outcome (PASO) criteria. Long term all-cause mortality was the primary outcome. Secondary outcomes were incident MACE, atrial fibrillation (Af) or congestive heart failure (CHF) after the PA confirmatory diagnosis.Findings: 272 (49.9%) of the 545 surgically-treated cAPA patients achieved PASO clinical complete success (hypertension-remission without medications). After a follow-up of 6.3±4.0 years, both hypertension-remissive (HR, 0.54, p 27 ng/dL after adrenalectomy or plasma renin activity < 0.6 ng/mL/hr after MRA treatment could be associated with higher risks of mortality or MACE.Interpretation: Adrenalectomy, independent of post-surgical hypertension-remission, was associated with lower all-cause mortality of cAPA patients. However, post-adrenalectomy non-cured hypertension and/or MRA therapy in cAPA patients could still have higher MACE risk than that of the EH controls. We further documented a more beneficial effect of adrenalectomy over MRA treatment on long-term mortality, MACE, and CHF in cAPA patients.Trial Registration: NCT00917345Funding Statement: This study was supported by Taiwan National Science Council (grants NSC 101- 2314-B-002-132-MY3, NSC100-2314-B-002-119, NSC 101-2314-B-002-085-MY3, MOST 104- 2314-B-002 -125 -MY3) and NTUH 100-N1776, 101-M1953, 102-S2097.Declaration of Interests: No competing interest was declared. No financial conflict of interest exists.Ethics Approval Statement: Ethical approval (approval number: 201801049RIND, NCT00917345) was obtained from the institutional review board of the National Taiwan University Hospital." @default.
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- W3133627209 date "2021-01-01" @default.
- W3133627209 modified "2023-10-16" @default.
- W3133627209 title "Long-Term Mortality and Cardiac Outcomes in Patients With Clinical Aldosterone Producing Adenomas After Target Treatments" @default.
- W3133627209 doi "https://doi.org/10.2139/ssrn.3784661" @default.
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