title: Long term outcome of Aldosteronism after target treatments.
abstract: There exists a great knowledge gap in terms of long-term effects of various surgical and pharmacological treatments on outcomes among primary aldosteronism (PA) patients. Using a validated algorithm, we extracted longitudinal data for all PA patients diagnosed in 1997-2010 and treated in the Taiwan National Health Insurance. We identified 3362 PA patients for whom the mean length of follow-up was 5.75 years. PA has higher major cardiovascular events (MACE) than essential hypertension (23.3% vs 19.3%, p = 0.015). Results from the Cox model suggest a strong effect of adrenalectomy on lowering mortality (HR = 0.23 with residual hypertension and 0.21 with resolved hypertension). While the need for mineralocorticoid receptor antagonist (MRA) after diagnosis suggests that a defined daily dose (DDD) of MRA between 12.5 and 50 mg may alleviate risk of death in a U-shape pattern. A specificity test identified patients who has aldosterone producing adenoma (HR = 0.50, p = 0.005) also confirmed adrenalectomy attenuated all-cause mortality. Adrenalectomy decreases long-term all-cause mortality independently from PA cure from hypertension. Prescription corresponding to a DDD between 12.5 and 50 mg may decrease mortality for patients needing MRA. It calls for more attention on early diagnosis, early treatment and prescription of appropriate dosage of MRA for PA patients.
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Vin-Cent
authors: VC
authors: Wu
authors: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
authors: Shuo-Meng
authors: SM
authors: Wang
authors: Department of internal medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
authors: Chia-Hui
authors: CH
authors: Chang
authors: Department of internal medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
authors: Ya-Hui
authors: YH
authors: Hu
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Lian-Yu
authors: LY
authors: Lin
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Yen-Hung
authors: YH
authors: Lin
authors: Cleveland Clinic Lerner College of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, USA.
authors: Shih-Chieh Jeff
authors: SC
authors: Chueh
authors: Institute of Population Health Sciences, National Health Research Institutes, No. 35, Keyan Road, Zhunan 350, Taiwan.
authors: Likwang
authors: L
authors: Chen
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Kwan-Dun
authors: KD
authors: Wu
mesh_terms: D000315:Adrenalectomy; D000328:Adult; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D057216:Propensity Score; D016016:Proportional Hazards Models; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000451:Mineralocorticoid Receptor Antagonists