Mineralocorticoid receptor antagonist treatment improved arterial stiffness in patients with primary aldosteronism: a cohort study compared with adrenalectomy

Author:

Liao Che-Wei1ORCID,Lin Yen-Tin2,Tsai Cheng-Hsuan3ORCID,Chang Yi-Yao4,Chen Zheng-Wei5,Lu Ching-Chu6,Pan Chien-Ting5,Chang Chin-Chen7,Lee Bo-Ching7,Chiu Yu-Wei4,Huang Wei-Chieh8,Huang Kuo-How9,Lai Tai-Shuan3,Hung Chi-Shen3,Wu Vin-Cent3,Wu Xue-Ming10,Lin Yen-Hung3,

Affiliation:

1. Department of Internal Medicine, National Taiwan University Cancer Center, Taipei

2. Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan

3. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei

4. Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City

5. Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu

6. Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei

7. Department of Medical Imaging, National Taiwan University Hospital, Taipei

8. Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei

9. Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei

10. Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan City

Abstract

Background: Elevated arterial stiffness in patients with primary aldosteronism (PA) can be reversed after adrenalectomy; however, the effect of medical treatment with mineralocorticoid receptor antagonist (MRAs) is unknown. Objectives: The aim of this study was to evaluate the effect of MRAs and compare both treatment strategies on arterial stiffness in PA patients. Design: Prospective cohort study. Methods: We prospectively enrolled PA patients from 2006 to 2019 who received either adrenalectomy or MRA treatment (spironolactone). We compared their baseline and 1-year post-treatment biochemistry characteristics and arterial pulse wave velocity (PWV) to verify the effects of treatment and related determinant factors. Results: A total 459 PA patients were enrolled. After 1:1 propensity score matching for age, sex and blood pressure (BP), each group had 176 patients. The major determinant factors of baseline PWV were age and baseline BP. The adrenalectomy group had greater improvements in BP, serum potassium level, plasma aldosterone concentration, and aldosterone-to-renin ratio. The MRA group had a significant improvement in PWV after 1 year of treatment (1706.2 ± 340.05 to 1613.6 ± 349.51 cm/s, p < 0.001). There were no significant differences in post-treatment PWV ( p = 0.173) and improvement in PWV ( p = 0.579) between the adrenalectomy and MRA groups. The determinant factors for an improvement in PWV after treatment were hypertension duration, baseline PWV, and the decrease in BP. Conclusion: The PA patients who received medical treatment with MRAs had a significant improvement in arterial stiffness. There was no significant difference in the improvement in arterial stiffness between the two treatment strategies.

Funder

National Taiwan University Hospital

Department of Biotechnology , Ministry of Science and Technology

National Taiwan University Cancer Center

National Taiwan University Hospital Hsinchu Branch

Publisher

SAGE Publications

Subject

Medicine (miscellaneous)

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