Cardiovascular Outcomes in Patients With Primary Aldosteronism After Treatment

Catena, Cristiana; Colussi, GianLuca; Nadalini, Elisa; Chiuch, Alessandra; Baroselli, Sara; Lapenna, Roberta; Sechi, Leonardo A.

doi:10.1001/archinternmed.2007.33

Cited by 498 publications

(357 citation statements)

References 36 publications

(46 reference statements)

Supporting

Mentioning

325

Contrasting

Unclassified

Order By: Relevance

“…Although mineralocorticoid receptor antagonists produced multi-directional anti-inflammatory effects, their monocyte-and lymphocyte-suppressive effects did not increase with time, and cytokine release was higher than in control subjects during the entire observation period. These findings are in disagreement with those of other authors [8][9][10] who observed similar cardiovascular and nephroprotective benefits after adrenalectomy and spironolactone treatment. However, their study populations included both patients with aldosteronoma (most of whom underwent adrenalectomy) and patients with bilateral adrenal hyperplasia (treated with spironolactone), and this fact may explain the differences between our results and their results.…”

contrasting

confidence: 99%

The effect of treatment on monocyte and lymphocyte cytokine release in patients with aldosteronoma

Krysiak

2011

Hypertens Res

View full text Add to dashboard Cite

contrasting

confidence: 99%

The effect of treatment on monocyte and lymphocyte cytokine release in patients with aldosteronoma

Krysiak

2011

Hypertens Res

View full text Add to dashboard Cite

“…[29][30][31][32][33][34][35] A prospective study compared cardiovascular events in 54 PA patients treated by adrenalectomy (unilateral disease) or with spironolactone (unilateral or bilateral disease) with 323 patients with essential hypertension. 36 The composite endpoint was myocardial infarction, stroke, any type of revascularization procedure, and sustained arrhythmia. Its incidence over a mean follow-up of 7.4 years did not differ between patients with treated PA and their controls (who achieved similar BP levels throughout follow-up).…”

Section: Outcomes Of Adrenalectomy In Unilateral Pamentioning

confidence: 99%

“…29,34,85 The benefits of PA treatment were similar for specific drugs and surgery in both studies comparing the incidence of cardiovascular events in treated PA patients and matched controls with essential hypertension. 36,37 The relative glomerular hyperfiltration and microalbuminuria of PA patients are corrected on specific drugs (Figure 1). 40,[44][45][46]50,51,[53][54][55] Spironolactone was found to be less effective than surgery for achieving this end in one study using a fixed low dose (50 mg/day).…”

Section: Outcomes Of Drug-based Treatmentmentioning

confidence: 99%

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Steichen

Lorthioir

Zinzindohoué

et al. 2015

Advances in Chronic Kidney Disease

View full text Add to dashboard Cite

Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure and medications in most cases, and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control blood pressure. Dietary sodium restriction should be implemented in all cases, because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of blood pressure, serum potassium concentration or cardiovascular and renal outcomes, although the benefits of treatment tend to be observed sooner with surgery.PA patients display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing chronic kidney disease in 30% of patients. However, further kidney damage is prevented by the treatment of PA. Clinical summary-The goals of treatment are the normalization of serum potassium concentration, blood pressure control and prevention of the direct effects of excess aldosterone on target organs. 3-The non-surgical treatment of PA is based on mineralocorticoid receptor antagonists and dietary sodium restriction.-Epithelial sodium channel blockers are used when mineralocorticoid receptor antagonists are not well tolerated; thiazide diuretics and calcium channel blockers are used when blood pressure control is insufficient with the first-line treatment.-Laparoscopic adrenalectomy is safe and decreases BP and medication requirements in patients with unilateral PA; drug-based treatments are appropriate in cases in which surgery is inappropriate or not desired.

show abstract

“…Consequently, treatment objectives include correction for aldosterone hypersecretion or for the excess stimulation of mineralocorticoid receptors (21). In patients with lateralized aldosterone hypersecretion, this goal can be achieved by adrenalectomy and probably by the long-term prescription of MRAs (22), and MRAs provide a specific treatment for PA in patients who are not candidates for surgery.…”

Section: Amiloridementioning

confidence: 99%

PROGRESS IN PRIMARY ALDOSTERONISM: Mineralocorticoid antagonist treatment for aldosterone-producing adenoma

Amar

Lorthioir

Azizi

et al. 2015

European Journal of Endocrinology

View full text Add to dashboard Cite

Mineralocorticoid receptor antagonists have been used in patients with aldosterone-producing adenomas (APAs) as a test designed to predict the blood pressure (BP) outcome of surgery. They are commonly used in patients undergoing adrenalectomy to reduce BP and increase plasma potassium levels during the preoperative period. A small number of studies have compared the effects of surgery and mineralocorticoid antagonists either on BP, on serum potassium levels, or on the incidence of cardiovascular and renal outcomes in patients with primary aldosteronism with or without an APA; these studies found no difference between the two therapeutic options. Mineralocorticoid receptor antagonists can be used as a maintenance treatment for patients with APAs, who are judged to be poor operative risks or who do not want to undergo surgery.

show abstract

Cardiovascular Outcomes in Patients With Primary Aldosteronism After Treatment

Abstract: Primary aldosteronism is associated with a cardiovascular complication rate out of proportion to blood pressure levels that benefits substantially from surgical and medical treatment in the long term.

Cited by 498 publications

References 36 publications

The effect of treatment on monocyte and lymphocyte cytokine release in patients with aldosteronoma

The effect of treatment on monocyte and lymphocyte cytokine release in patients with aldosteronoma

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

PROGRESS IN PRIMARY ALDOSTERONISM: Mineralocorticoid antagonist treatment for aldosterone-producing adenoma

Contact Info

Product

Resources

About