Primary aldosteronism and cardiovascular risk, before and after treatment

In The Lancet Diabetes & Endocrinology, two new reports are of particular relevance to the clinical management of primary aldosteronism. 1 Monticone S D'Ascenzo F Moretti C et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2017; (published online Nov 9.)http://dx.doi.org/10.1016/S2213-8587(17)30319-4 Summary Full Text Full Text PDF PubMed Scopus (416) Google Scholar , 2 Hundemer GL Curhan GC Yozamp N Wang M Vaidya A Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2017; (published online Nov 9.)http://dx.doi.org/10.1016/S2213-8587(17)30367-4 Summary Full Text Full Text PDF PubMed Scopus (288) Google Scholar The first, from Silvia Monticone and colleagues, is a systematic review and meta-analysis comparing patients with primary aldosteronism with those with essential hypertension at the time of presentation. 1 Monticone S D'Ascenzo F Moretti C et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2017; (published online Nov 9.)http://dx.doi.org/10.1016/S2213-8587(17)30319-4 Summary Full Text Full Text PDF PubMed Scopus (416) Google Scholar Although the 31 observational studies are classified as prospective or retrospective, all look backward to differences between 3838 patients with primary aldosteronism versus 9284 with essential hypertension. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysisDiagnosing primary aldosteronism in the early stages of disease, with early initiation of specific treatment, is important because affected patients display an increased cardiovascular risk compared with patients with essential hypertension. Full-Text PDF Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort studyThe current practice of MR antagonist therapy in primary aldosteronism is associated with significantly higher risk for incident cardiometabolic events and death, independent of blood pressure control, than for patients with essential hypertension. Titration of MR antagonist therapy to raise renin might mitigate this excess risk. Full-Text PDF