医学
原发性醛固酮增多症
MRAS公司
肾上腺切除术
不利影响
内科学
盐皮质激素受体
重症监护医学
血压
醛固酮
量子力学
感应电动机
物理
病媒控制
电压
作者
Sandeep Samethadka Nayak,Ehsan Amini‐Salehi,Farahnaz Joukar,Partha Sarathi Biswas,Sara Nobakht,Negin Letafatkar,Parham Porteghali,Erfan Mohammadi-Vajari,Fariborz Mansour-Ghanaei,Mona Javid,Arian Mirdamadi,Daniel Ameen,Hossein Hemmati,Soheil Hassanipour,Mohammad-Hossein Keivanlou
标识
DOI:10.1097/js9.0000000000002048
摘要
Background: Primary aldosteronism (PA) is now recognized as the most prevalent form of secondary hypertension globally, contributing significantly to cardiovascular morbidity and mortality. This umbrella review aims to systematically compare cardiovascular outcomes and all-cause mortality in PA patients undergoing adrenalectomy versus mineralocorticoid receptor antagonist (MRA) treatment, aiming to inform optimal management strategies. Method: Following PRISMA guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/D386, Supplemental Digital Content 2, http://links.lww.com/JS9/D387, a comprehensive search strategy was employed across multiple databases. Meta-analyses focusing on cardiovascular outcomes or all-cause mortality, comparing adrenalectomy and MRAs treatment in PA patients, were included. Studies were independently screened and assessed for quality using AMSTAR 2, Supplemental Digital Content 3, http://links.lww.com/JS9/D388 and GRADE checklists. Results: A total of 8 studies met the inclusion criteria. Adrenalectomy showed potential benefits over MRAs in reducing the risk of arrhythmias (OR=2.17; 95% CI: 1.25-3.76) and major adverse cardiovascular events (OR=1.81; 95% CI: 1.33-2.46). Patients treated with MRAs exhibited a higher risk of cardiovascular events (OR=1.23; 95% CI: 1.05-1.44), hypertension (OR=3.22; 95% CI: 1.15-8.97), and all-cause mortality (OR=3.03; 95% CI: 1.36-6.70) compared to adrenalectomy. Conclusion: Adrenalectomy appears to offer favorable outcomes compared to MRAs treatment in PA patients, particularly in reducing the risk of major adverse cardiovascular events and all-cause mortality. These findings suggest the importance of considering surgical intervention as a primary treatment modality for PA.
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