Benameur Sofia, Bertolino Julien, Bonnaud Laura, Nguyen Ngoc Anh Thu, Leclercq Barbara, Silhol François, Castinetti Frederic, Sebag Frederic, Vaisse Bernard, Sarlon-Bartoli Gabrielle
Vascular Medicine and Arterial Hypertension Department, La Timone Hospital, Marseille, France.
Medical Evaluation Service, AP-HM, CIC-CPCET, Marseille, France.
J Clin Hypertens (Greenwich). 2025 Aug;27(8):e70128. doi: 10.1111/jch.70128.
The study aims to evaluate the long-term incidence of cardiovascular events (CVE) and compare the effectiveness of medical and surgical interventions using a combined cardiovascular endpoint in individuals diagnosed with primary aldosteronism (PA). The authors carried out a multicentric, retrospective study in Marseille on a total of 106 inpatients divided into two samples with biologically proven primary aldosteronism, of whom 55 underwent surgical treatment and 51 received medical therapy between January 2014 and December 2022. The mean age of the sample was 53 years. Over a 54-month follow-up period, five patients in the medical group (10.64%) and three in the surgical group (5.45%) experienced a CVE (p = 0.46). Although the difference was not statistically significant, the surgical group had more cardiovascular morbidity at baseline. At the end of the follow-up, the surgical group demonstrated a significant reduction in blood pressure (BP) (mean 126/74 mmHg) compared to the medical group (mean 136/81 mmHg) (p = 0.02), with a significantly lower number of antihypertensive medications (1.23 ± 1.5 vs. 2.83 ± 1.8, p < 0.01). Additionally, the surgical group had a significantly higher serum potassium level at the end of follow-up despite similar potassium supplementation. The long-term incidence of CVE in PA did not significantly differ between medical and surgical treatment. However, there appears to be a trend toward reduced CVE over the long term in surgically treated patients who had excess cardiovascular morbidity at baseline. In addition, surgical treatment significantly improved BP control, with patients requiring fewer and demonstrating better serum potassium regulation.
本研究旨在评估心血管事件（CVE）的长期发生率，并比较采用综合心血管终点指标对原发性醛固酮增多症（PA）患者进行药物和手术干预的有效性。作者在马赛进行了一项多中心回顾性研究，共纳入106例住院患者，这些患者被分为两个经生物学证实为原发性醛固酮增多症的样本，其中55例接受了手术治疗，51例在2014年1月至2022年12月期间接受了药物治疗。样本的平均年龄为53岁。在54个月的随访期内，药物治疗组有5例患者（10.64%）发生了CVE，手术治疗组有3例患者（5.45%）发生了CVE（p = 0.46）。尽管差异无统计学意义，但手术治疗组在基线时的心血管发病率更高。随访结束时，与药物治疗组（平均136/81 mmHg）相比，手术治疗组的血压（BP）显著降低（平均126/74 mmHg）（p = 0.02），且抗高血压药物的使用数量显著减少（1.23±1.5 vs. 2.83±1.8，p < 0.01）。此外，尽管补钾情况相似，但手术治疗组在随访结束时的血清钾水平显著更高。PA患者中CVE的长期发生率在药物治疗和手术治疗之间无显著差异。然而，对于基线时心血管发病率较高的手术治疗患者，似乎有长期CVE减少的趋势。此外，手术治疗显著改善了血压控制，患者所需的抗高血压药物更少，血清钾调节情况更好。
