Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
Sci Rep. 2016 Sep 2;6:32103. doi: 10.1038/srep32103.
There exists a great knowledge gap in terms of long-term effects of various surgical and pharmacological treatments on outcomes among primary aldosteronism (PA) patients. Using a validated algorithm, we extracted longitudinal data for all PA patients diagnosed in 1997-2010 and treated in the Taiwan National Health Insurance. We identified 3362 PA patients for whom the mean length of follow-up was 5.75 years. PA has higher major cardiovascular events (MACE) than essential hypertension (23.3% vs 19.3%, p = 0.015). Results from the Cox model suggest a strong effect of adrenalectomy on lowering mortality (HR = 0.23 with residual hypertension and 0.21 with resolved hypertension). While the need for mineralocorticoid receptor antagonist (MRA) after diagnosis suggests that a defined daily dose (DDD) of MRA between 12.5 and 50 mg may alleviate risk of death in a U-shape pattern. A specificity test identified patients who has aldosterone producing adenoma (HR = 0.50, p = 0.005) also confirmed adrenalectomy attenuated all-cause mortality. Adrenalectomy decreases long-term all-cause mortality independently from PA cure from hypertension. Prescription corresponding to a DDD between 12.5 and 50 mg may decrease mortality for patients needing MRA. It calls for more attention on early diagnosis, early treatment and prescription of appropriate dosage of MRA for PA patients.
在原发性醛固酮增多症（PA）患者中，各种手术和药物治疗对结局的长期影响存在很大的知识差距。我们使用经过验证的算法，提取了 1997 年至 2010 年间诊断并在台湾全民健康保险中治疗的所有 PA 患者的纵向数据。我们确定了 3362 名 PA 患者，他们的平均随访时间为 5.75 年。PA 的主要心血管事件（MACE）发生率高于原发性高血压（23.3%对 19.3%，p=0.015）。Cox 模型的结果表明，肾上腺切除术对降低死亡率有很强的作用（残余高血压时 HR=0.23，高血压缓解时 HR=0.21）。诊断后需要使用盐皮质激素受体拮抗剂（MRA）表明，MRA 的定义日剂量（DDD）在 12.5 至 50mg 之间可能呈 U 形模式缓解死亡风险。特异性检验确定了产生醛固酮的腺瘤患者（HR=0.50，p=0.005），也证实了肾上腺切除术减轻了全因死亡率。肾上腺切除术可降低全因死亡率，与高血压的 PA 治愈率无关。处方对应的 DDD 在 12.5 至 50mg 之间可能会降低需要 MRA 的患者的死亡率。这呼吁对 PA 患者进行早期诊断、早期治疗和适当剂量的 MRA 处方给予更多关注。
