New-Onset Atrial Fibrillation in Patients With Primary Aldosteronism Receiving Different Treatment Strategies: Systematic Review and Pooled Analysis of Three Studies

Tsai, Cheng-Ting; Chen, Yali; Pan, Chien‐Ting; Lin, Yen-Tin; Lee, Po-Chin; Chiu, Yu‐Wei; Liao, Che‐Wei; Chen, Zheng-Wei; Chang, Chin‐Chen; Chang, Yuan‐Jen; Hung, Chi‐Sheng; Lin, Yen‐Hung

doi:10.3389/fendo.2021.646933

Cited by 12 publications

(5 citation statements)

References 49 publications

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“…Conversely, PA testing was less frequent in patients with history of coronary artery events or atrial fibrillation. These cardiovascular complications have also been associated with PA 13 , 40 , 41 , 42 via aldosterone‐mediated fibrosis, cardiac remodeling, and endothelial dysfunction. 7 , 8 , 9 , 10 , 11 , 12 , 43 Despite this, our data confirm that most clinicians do not associate coronary artery disease and cardiac arrythmias with PA.…”

Section: Discussionmentioning

confidence: 99%

Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities

Turcu

Nhan

Grigoryan

et al. 2022

JAHA

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Background Primary aldosteronism (PA) is a common but under‐recognized cause of secondary hypertension. Data directly comparing screening rates across single and overlapping indications are lacking. Methods and Results We conducted a retrospective review of adults with hypertension seen in outpatient clinics at a tertiary referral academic center between January 1, 2017, and June 30, 2020. We included patients with hypertension plus at least one of the following: resistant hypertension; age<35 years; obstructive sleep apnea; hypokalemia; or an adrenal mass. We excluded patients with adrenal insufficiency, severe renal disease, or heart failure, and renovascular hypertension. Of 203 535 patients with hypertension, 86044 (42.3%) met at least 1 PA screening criterion, and of these, 2898 (3.4%) were screened for PA. Screening occurred in 2.7% of patients with resistant hypertension; 4.2% of those with obstructive sleep apnea; 5.1% of those <35 years; 10.0% of those with hypokalemia; and 47.3% of patients with an adrenal mass. Screening rates were higher in patients with multiple risk factors: 16.8% for ≥3, 5.7% for 2, and 2.5% for 1 criterion. Multiple logistic regression showed that the odds of PA screening were higher in patients with hypokalemia: odds ratio (95% CI): 3.0 (2.7–3.3); women: 1.3 (1.2–1.4); Black versus White: 1.5 (1.4–1.7); those with obstructive sleep apnea, chronic renal disease, stroke, and dyslipidemia. Conclusions Consideration for PA is given in a small subset of at‐risk patients, and typically after comorbidities have developed.

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Section: Discussionmentioning

confidence: 99%

Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities

Turcu

Nhan

Grigoryan

et al. 2022

JAHA

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“…It is clear that complexity of PA remains a relevant factor and each case deserve accurate investigation. Furthermore, a complete abolition of the PA-related increased risk for new-onset AF has been documented in PA patients cured by unilateral adrenalectomy [19]. Due to several factors of atrial fibrillation and not related to hyperaldosteronism, the physicians need caution both in diagnosis and in therapy suggestions.…”

Section: Discussion and Resultsmentioning

confidence: 99%

Atrial Fibrillation and Primary Aldosteronism: A Meta-Analysis

2023

Cardiol Res Cardiovasc Med

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Primary Aldosteronism (PA) is a condition notoriously causing serious damage to cardiovascular system. It is reported that regardless of high blood pressure high level of long exposition of aldosterone determine target organ damage and predisposes to atrial fibrillation. Arterial hypertension is a major risk factor for atrial fibrillation (AF) and between 50% and 90% of AF patients have hypertension [22]. PA patients were reported to have a highly significant 12-fold higher risk of AF than essential hypertensive patients [23]. We searched on PubMed, Cochrane library and Web of science for clinical studies on the prevalence of arrhythmias such as atrial fibrillation and cerebrovascular events among PA patients. In this meta-analysis we want to evaluate the risk of AF associated to hyperaldosteronism because there are results not always clear that deserve a further investigation. The results show us that AF is a prevalence risk associated with PA vs EH. As for the stroke events, the results show that AF as prevalence is not associated with PA vs EH.

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“…This meta-analysis enrolled 2,705 patients with PA, and the results demonstrated that the incidence of NOAF among the patients with PA receiving treatment with MRA was much higher compared to those inpatients for PA who underwent ADX (pooled OR: 2.83, 95% CI: 1.76-4.57 in the random-effects model). The pooled OR was 1.91 (95% CI: 1.11-3.28) when compared to the patients with EH (205). These data suggested that persistent renin suppression may serve as a biomarker for inadequate MR blockade, leading to ongoing aldosterone exposure and consequent cardiometabolic effects.…”

Section: Cerebro-cardiovascular Outcomesmentioning

confidence: 88%

Cerebro-Cardiovascular Risk, Target Organ Damage, and Treatment Outcomes in Primary Aldosteronism

Lin

Ullah

Xiong

et al. 2022

Front. Cardiovasc. Med.

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Primary aldosteronism (PA) is the most common type of endocrine hypertension, and numerous experimental and clinical evidence have verified that prolonged exposure to excess aldosterone is responsible for an increased risk of cerebro-cardiovascular events and target organ damage (TOD) in patients with PA. Therefore, focusing on restoring the toxic effects of excess aldosterone on the target organs is very important to reduce cerebro-cardiovascular events. Current evidence convincingly demonstrates that both surgical and medical treatment strategies would benefit cerebro-cardiovascular outcomes and mortality in the long term. Understanding cerebro-cardiovascular risk in PA would help clinical doctors to achieve both early diagnosis and treatment. Therefore, in this review, we will summarize the cerebro-cardiovascular risk in PA, focusing on the TOD of aldosterone, including brain, heart, vascular system, renal, adipose tissues, diabetes, and obstructive sleep apnea (OSA). Furthermore, the various treatment outcomes of adrenalectomy and medical treatment for patients with PA will also be discussed. We hope this knowledge will help improve cerebro-cardiovascular prognosis and reduce the incidence and mortality of cerebro-cardiovascular events in patients with PA.

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New-Onset Atrial Fibrillation in Patients With Primary Aldosteronism Receiving Different Treatment Strategies: Systematic Review and Pooled Analysis of Three Studies

Cited by 12 publications

References 49 publications

Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities

Primary Aldosteronism Screening Rates Differ with Sex, Race, and Comorbidities

Atrial Fibrillation and Primary Aldosteronism: A Meta-Analysis

Cerebro-Cardiovascular Risk, Target Organ Damage, and Treatment Outcomes in Primary Aldosteronism

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