Mineralocorticoid receptor antagonist treatment improved arterial stiffness in patients with primary aldosteronism: a cohort study compared with adrenalectomy.
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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.
背景:原发性醛固酮增多症(PA)患者动脉僵硬度升高可以在肾上腺切除术后逆转;然而，矿物皮质激素受体拮抗剂(MRAs)药物治疗的效果尚不清楚。目的:本研究的目的是评估MRAs的效果，并比较两种治疗策略对PA患者动脉僵硬的影响。设计:前瞻性队列研究。方法:我们前瞻性地招募了2006年至2019年期间接受肾上腺切除术或MRA治疗(螺内酯)的PA患者。我们比较了他们的基线和治疗后1年的生化特征和动脉脉搏波速度(PWV)，以验证治疗的效果和相关的决定因素。结果:共纳入459例PA患者。根据年龄、性别和血压进行1:1的倾向评分匹配后，每组176例患者。基线PWV的主要决定因素是年龄和基线血压。肾上腺切除术组血压、血钾水平、血浆醛固酮浓度、醛固酮-肾素比改善较大。MRA组治疗1年后PWV显著改善(1706.2±340.05 ~ 1613.6±349.51 cm/s, p p = 0.173)，与MRA组相比PWV显著改善(p = 0.579)。治疗后PWV改善的决定因素是高血压病程、基线PWV和血压下降。结论:PA患者接受MRAs治疗后，动脉僵硬度有明显改善。两种治疗策略在改善动脉僵硬方面没有显著差异。
期刊介绍：
Therapeutic Advances in Chronic Disease publishes the highest quality peer-reviewed research, reviews and scholarly comment in the drug treatment of all chronic diseases. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers involved in the medical treatment of chronic disease, providing a forum in print and online for publishing the highest quality articles in this area.
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