Cardiovascular Outcomes in Patients With Primary Aldosteronism After Treatment

原发性醛固酮增多症 医学 心脏病学 螺内酯 内科学 血压 醛固酮 原发性高血压 心肌梗塞 优势比 肾上腺切除术 继发性高血压 临床终点 随机对照试验
作者
Cristiana Catena
出处
期刊:Archives of internal medicine [American Medical Association]
卷期号:168 (1): 80-80 被引量:512
标识
DOI:10.1001/archinternmed.2007.33
摘要

Background

Experimental and human studies demonstrate that long-term exposure to elevated aldosterone levels results in cardiac and vascular damage.

Methods

We investigated long-term cardiovascular outcomes in patients with primary aldosteronism after surgical or medical treatment. Fifty-four patients with or without evidence of adrenal adenomas were prospectively followed up for a mean of 7.4 years after treatment with adrenalectomy or spironolactone. Patients with primary aldosteronism were compared with patients with essential hypertension and were treated to reach a blood pressure of less than 140/90 mm Hg. The main outcome measure was a combined cardiovascular end point comprising myocardial infarction, stroke, any type of revascularization procedure, and sustained arrhythmias.

Results

At baseline, the prevalence of cardiovascular events was greater in primary aldosteronism (35%) than in essential hypertension (11%) (odds ratio, 4.61; 95% confidence interval, 2.38-8.95;P < .001), with odds ratios of 4.93, 4.36, and 2.80 for sustained arrhythmias, cerebrovascular events, and coronary heart disease, respectively. Blood pressure during follow-up was comparable in the primary aldosteronism and essential hypertension groups. Ten patients in the primary aldosteronism group and 19 in the essential hypertension group reached the primary end point (P = .85). Cox analysis indicated that older age and longer duration of hypertension were factors independently associated with the cardiovascular end point. Cardiovascular outcome was comparable in patients with aldosteronism treated with adrenalectomy vs aldosterone antagonists (P = .71).

Conclusion

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.
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