Cardiovascular and Renal Outcomes in Unilateral Primary Hyperaldosteronism: Comparative Study Between Adrenalectomy and Medical Treatment

Presentation Number: SUN 527
Date of Presentation: April 2nd, 2017

Takuyuki Katabami*1, Hisashi Fukuda2, Hiroshi Ito3, Isao Kurihara4, Yoshiyu Takeda5, Takamasa Ichijo6, Mika Tsuiki7, Hironobu Umakoshi7, Yasushi Tanaka8, Mitsuhide Naruse7 and Jpas Group9
1St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama-shi Kanagawa, Japan, 2St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan, 3Keio University School of Medicine, 4School of Medicine, Keio University, Tokyo, Japan, 5Kanazawa University, Kanazawa, Japan, 6Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan, 7National Hospital Organization Kyoto Medical Center, Kyoto, Japan, 8St. Marianna University School of Medicine, Japan, 9National Hospital Organization Kyoto Medical Center

Abstract

Objectives: Current clinical guidelines on primary aldosteronism (PA) recommend adrenalectomy (ADx) for unilateral PA (UPA). However, there is limited evidence that ADx is superior to medical treatment (MTx) in patients with UPA. The purpose of the present study was to retrospectively compare cardiovascular (CV) and renal outcomes between ADx and MTx. Subjects and Methods: We organized a Japan PA study (JPAS) group involving 33 hospitals. Patients diagnosed with PA based on a positive result in case detection with aldosterone to renin ratio (ARR >20), along with at least one positive confirmatory test between January 2006 and December 2015, were enrolled (N=2172). Subtype diagnosis was based on adrenal venous sampling (AVS). The primary outcome measures included detection of new onset of CV events, proteinuria, and changes in the estimated glomerular filtration rate (eGFR) after therapeutic intervention. Results: Of the 714 (33%) patients with UPA, 503 (70%) underwent ADx and 211 (30%) received MTx. The median observation periods were10.5 months in the ADx group and 14.5 months in the MTx group. At baseline, plasma aldosterone concentration and ARR were higher in the ADx group than in the MTx group, while the serum potassium (SK) levels, body mass index, and age were lower in the ADx group than in the MTx group. Blood pressure (BP), eGFR, prevalence of CV events and proteinuria, and duration of hypertension were comparable between the two groups. After treatment, BP and the SK levels were improved in both groups with systolic BP lower in the ADx group than in the MTx group. However, there were no significant difference of incidence of CV events (ADx group: 31 events, 8 %; MTx group: 7 events, 6.4%) , positive rate of proteinuria, and changes in the eGFR between the two groups. The results of CV and renal outcomes were confirmed even after adjusting various clinical backgrounds of the two groups using propensity score matching. Conclusion: The results clearly demonstrated that ADx was not superior to MTx with regard to CV and renal outcomes in patients with UPA during approximately 1 year observation. CV and/or renal protection could not be the reason with the highest priority in indicating ADx rather than MTx in patients with UPA. Further long-term observation studies are needed to verify the present results.

Nothing to Disclose:

Sources of Research Support : Supported by grants-in-aid from the Practical Research Project for Rare/Intractable Disease of the Japan Agency for Medical Research and Development, AMED, Japan (15Aek0109122).

 

Disclosure: TK: Protocol review committee, ONO-Pharma, Investigator, ONO-Pharma. MT: Investigator, ONO-Pharma. MN: Coordinating Investigator, ONO-Pharma, Investigator, ONO-Pharma. Nothing to Disclose: HF, HI, IK, YT, TI, HU, YT, JG