Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy.
Lancet Diabetes Endocrinol. 2018 Jan;6(1):41-50. doi: 10.1016/S2213-8587(17)30319-4. Epub 2017 Nov 9.
There is conflicting evidence, relying on heterogeneous studies, as to whether aldosterone excess is responsible for an increased risk of cardiovascular and cerebrovascular complications in patients with primary aldosteronism. We aimed to assess the association between primary aldosteronism and adverse cardiac and cerebrovascular events, target organ damage, diabetes, and metabolic syndrome, compared with the association of essential hypertension and these cardiovascular and end organ events, by integrating results of previous studies.
We did a meta-analysis of prospective and retrospective observational studies that compared patients with primary aldosteronism and essential hypertension, to analyse the association between primary aldosteronism and stroke, coronary artery disease (as co-primary endpoints), atrial fibrillation and heart failure, target organ damage, metabolic syndrome, and diabetes (as secondary endpoints). We searched MEDLINE and Cochrane Library for articles published up to Feb 28, 2017, with no start date restriction. Eligible studies compared patients with primary aldosteronism with patients with essential hypertension (as a control group) and reported on the clinical events or endpoints of interest. We also compared primary aldosteronism subtypes, aldosterone-producing adenoma, and bilateral adrenal hyperplasia.
We identified 31 studies including 3838 patients with primary aldosteronism and 9284 patients with essential hypertension. After a median of 8·8 years (IQR 6·2-10·7) from the diagnosis of hypertension, compared with patients with essential hypertension, patients with primary aldosteronism had an increased risk of stroke (odds ratio [OR] 2·58, 95% CI 1·93-3·45), coronary artery disease (1·77, 1·10-2·83), atrial fibrillation (3·52, 2·06-5·99), and heart failure (2·05, 1·11-3·78). These results were consistent for patients with aldosterone-producing adenoma and bilateral adrenal hyperplasia, with no difference between these subgroups. Similarly, primary aldosteronism increased the risk of diabetes (OR 1·33, 95% CI 1·01-1·74), metabolic syndrome (1·53, 1·22-1·91), and left ventricular hypertrophy (2·29, 1·65-3·17).
Diagnosing 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.
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依赖于异质研究的证据相互矛盾，即醛固酮过多是否导致原发性醛固酮增多症患者心血管和脑血管并发症的风险增加。我们旨在通过整合以前的研究结果，评估原发性醛固酮增多症与不良心脏和脑血管事件、靶器官损伤、糖尿病和代谢综合征之间的相关性，与原发性高血压和这些心血管和终末器官事件之间的相关性进行比较。
我们对前瞻性和回顾性观察性研究进行了荟萃分析，这些研究比较了原发性醛固酮增多症患者和原发性高血压患者，以分析原发性醛固酮增多症与中风、冠状动脉疾病（共同主要终点）、心房颤动和心力衰竭、靶器官损伤、代谢综合征和糖尿病（次要终点）之间的关系。我们检索了 MEDLINE 和 Cochrane 图书馆，检索时间截至 2017 年 2 月 28 日，没有起始日期限制。符合条件的研究比较了原发性醛固酮增多症患者和原发性高血压患者（作为对照组），并报告了感兴趣的临床事件或终点。我们还比较了原发性醛固酮增多症的亚型、醛固酮瘤和双侧肾上腺增生。
我们确定了 31 项研究，包括 3838 例原发性醛固酮增多症患者和 9284 例原发性高血压患者。从高血压诊断中位数 8.8 年（IQR 6.2-10.7）后，与原发性高血压患者相比，原发性醛固酮增多症患者中风（比值比 [OR] 2.58，95%CI 1.93-3.45）、冠状动脉疾病（1.77，1.10-2.83）、心房颤动（3.52，2.06-5.99）和心力衰竭（2.05，1.11-3.78）的风险增加。这些结果与醛固酮瘤和双侧肾上腺增生患者的结果一致，且这些亚组之间无差异。同样，原发性醛固酮增多症增加了糖尿病（OR 1.33，95%CI 1.01-1.74）、代谢综合征（1.53，1.22-1.91）和左心室肥厚（2.29，1.65-3.17）的风险。
早期诊断疾病的原发性醛固酮增多症，并早期开始特定治疗非常重要，因为与原发性高血压患者相比，受影响的患者表现出更高的心血管风险。
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