Nayak Sandeep S, Amini-Salehi Ehsan, Joukar Farahnaz, Biswas Pubali, Nobakht Sara, Letafatkar Negin, Porteghali Parham, Mohammadi-Vajari Erfan, Mansour-Ghanaei Fariborz, Javid Mona, Mirdamadi Arian, Ameen Daniyal, Motamed Behrang, Hassanipour Soheil, Keivanlou Mohammad-Hossein
Department of Internal Medicine, Division of Hospital Medicine, Yale New Haven Health, USA.
Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences.
Int J Surg. 2024 Nov 1;110(11):7367-7380. doi: 10.1097/JS9.0000000000002048.
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.
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.
A total of eight 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.
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.
原发性醛固酮增多症（PA）现已被公认为全球继发性高血压最常见的形式，对心血管发病率和死亡率有重大影响。本综述旨在系统比较接受肾上腺切除术与盐皮质激素受体拮抗剂（MRA）治疗的PA患者的心血管结局和全因死亡率，以指导最佳管理策略。
按照PRISMA指南（补充数字内容1，http://links.lww.com/JS9/D386 ）（补充数字内容2，http://links.lww.com/JS9/D387 ），在多个数据库中采用全面的检索策略。纳入聚焦于心血管结局或全因死亡率、比较PA患者肾上腺切除术和MRA治疗的荟萃分析。使用AMSTAR 2（补充数字内容3，http://links.lww.com/JS9/D388 ）和GRADE清单对研究进行独立筛选和质量评估。
共有八项研究符合纳入标准。肾上腺切除术在降低心律失常风险（比值比[OR]=2.17；95%置信区间[CI]：1.25 - 3.76）和主要不良心血管事件风险（OR=1.81；95%CI：1.33 - 2.46）方面显示出优于MRA的潜在益处。与肾上腺切除术相比，接受MRA治疗的患者发生心血管事件（OR=1.23；95%CI：1.05 - 1.44）、高血压（OR=3.22；95%CI：1.15 - 8.97）和全因死亡率（OR=3.03; 95%CI：1.36 - 6.70）的风险更高。
与MRA治疗相比，肾上腺切除术在PA患者中似乎能带来更好的结局，尤其是在降低主要不良心血管事件风险和全因死亡率方面。这些发现表明将手术干预作为PA的主要治疗方式的重要性。
