Department of Medical Education, National Taiwan University Hospital.
Department of Urology, National Taiwan University Hospital.
J Hypertens. 2023 Sep 1;41(9):1401-1410. doi: 10.1097/HJH.0000000000003479. Epub 2023 Jun 8.
The correlation of the changes of estimated glomerular filtration rate (eGFR) with long-term cardiovascular complications in patients with primary aldosteronism (PA) following mineralocorticoid receptor antagonists (MRA) treatment remains ambiguous. This prospective study aims to determine factors associated with all-cause mortality and de novo cardiovascular events of PA patients against the eGFR-dip.
A total of 208 newly diagnosed PA patients were enrolled from January 2017 to January 2019. MRA was administered with at least a 6-month follow-up. The 'eGFR-dip' was defined as the difference between eGFR at 6 months after MRA treatment and respective baseline eGFR divided by the baseline eGFR.
After a mean 5.7 years follow-up, an eGFR-dip more than 12%, which was detected in 99 (47.6%) of the 208 patients, was a significant independent risk factor predicting composite outcomes (all-cause mortality, de-novo three-point major adverse cardiovascular events, and/or congestive heart failure). Multivariable logistic regression showed that age [odds ratio (OR), 0.94; P = 0.003], pretreatment plasma aldosterone concentration (PAC; OR, 0.98; P = 0.004), and initial eGFR (OR, 0.97; P < 0.001) had a positive linkage with the eGFR-dip more than 12%.
Nearly half of PA patients had an eGFR-dip more than 12% after 6 months of MRA treatment. They had a higher incidence of all-cause mortality and de novo cardiovascular events. Elder age, higher pretreatment PAC, or higher initial eGFR could be associated with an elevated risk of an eGFR-dip more than 12%.
醛固酮受体拮抗剂（MRA）治疗后原发性醛固酮增多症（PA）患者估算肾小球滤过率（eGFR）变化与长期心血管并发症的相关性仍不明确。本前瞻性研究旨在确定与 eGFR 下降相关的因素，这些因素与 PA 患者的全因死亡率和新发心血管事件有关。
本研究共纳入 208 例 2017 年 1 月至 2019 年 1 月新诊断的 PA 患者。给予 MRA 治疗并进行至少 6 个月的随访。将“eGFR 下降”定义为 MRA 治疗后 6 个月的 eGFR 与各自基线 eGFR 的差值除以基线 eGFR。
经过平均 5.7 年的随访，208 例患者中有 99 例（47.6%）出现 eGFR 下降超过 12%，这是预测复合结局（全因死亡率、新发三点主要不良心血管事件和/或充血性心力衰竭）的独立危险因素。多变量 logistic 回归显示，年龄 [比值比（OR），0.94；P=0.003]、治疗前血浆醛固酮浓度（PAC；OR，0.98；P=0.004）和初始 eGFR（OR，0.97；P ＜0.001）与 eGFR 下降超过 12%有正相关关系。
近一半的 PA 患者在 MRA 治疗 6 个月后出现 eGFR 下降超过 12%。他们全因死亡率和新发心血管事件的发生率更高。年龄较大、治疗前 PAC 较高或初始 eGFR 较高可能与 eGFR 下降超过 12%的风险增加有关。
