title: Adrenalectomy is comparable with medical treatment for reduction of left ventricular mass in primary aldosteronism: meta-analysis of long-term studies.
abstract: BACKGROUND
  Primary aldosteronism (PA) is associated with an increase in left ventricular (LV) mass beyond the amount needed to compensate the hypertension-related workload. Available evidence suggests effectiveness of surgical treatment of PA in decreasing LV mass, whereas data on medical treatment are controversial. We have conducted a meta-analysis of long-term follow-up studies on surgical and medical treatment of PA to compare the effects of treatments on LV mass.
  
  
  METHODS
  Medline and Cochrane searches were performed including the following words: hyperaldosteronism, left ventricular mass, mineralocorticoid receptor antagonists, surgery, adrenalectomy, and follow-up studies. Studies published within 2013 focusing on cardiac effects of treatment and follow-up longer than 6 months were selected. Data extraction was performed independently by 2 authors.
  
  
  RESULTS
  Of 61 retrieved articles, 4 were included in the analysis. These studies enrolled 355 patients with PA who had an average follow-up of 4.0 years after unilateral adrenalectomy (n = 178) or treatment with mineralocorticoid receptor antagonists (n = 177). Despite greater effect of surgery over medical treatment in reducing blood pressure, meta-analysis of the selected studies demonstrated no significant difference in LV mass change between patients with PA who were treated with mineralocorticoid receptor antagonists or adrenalectomy (standard mean difference = 0.130; 95% confidence interval = -0.085 to 0.345; P = 0.24; I2 = 0%).
  
  
  CONCLUSIONS
  Available evidence indicates that reduction of LV mass is not different in PA patients treated with adrenalectomy or mineralocorticoid receptor antagonists.
authors.affiliation: Hypertension Unit, Clinica Medica, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy. luimar-@libero.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Marzano
authors.affiliation: Hypertension Unit, Clinica Medica, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Colussi
authors.affiliation: Hypertension Unit, Clinica Medica, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
authors.forename: Leonardo A
authors.initials: LA
authors.lastname: Sechi
authors.affiliation: Hypertension Unit, Clinica Medica, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Catena
mesh_terms: D000315:Adrenalectomy; D006352:Heart Ventricles / Q000187:drug effects / Q000473:pathology*; D006801:Humans; D006929:Hyperaldosteronism / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D009929:Organ Size / Q000187:drug effects
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: adrenalectomy; blood pressure; hyperaldosteronism; hypertension; left ventricular hypertrophy; left ventricular mass; mineralocorticoid receptor antagonists.