Outcomes after medical treatment for primary aldosteronism: an international consensus and analysis of treatment response in an international cohort

IF 44 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

The Lancet Diabetes & Endocrinology Pub Date : 2025-01-14 DOI:10.1016/s2213-8587(24)00308-5

Jun Yang, Jacopo Burrello, Jessica Goi, Martin Reincke, Christian Adolf, Evelyn Asbach, Denise Brűdgam, Qifu Li, Yi Song, Jinbo Hu, Shumin Yang, Fumitoshi Satoh, Yoshikiyo Ono, Renata Libianto, Michael Stowasser, Nanfang Li, Qing Zhu, Namki Hong, Drishya Nayak, Troy H Puar, Peter J Fuller

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引用次数: 0

Abstract

Background

Primary aldosteronism can be treated medically but there is no standardised method to evaluate treatment outcomes. We aimed to develop criteria for assessing the outcomes of targeted medical treatment of primary aldosteronism, analyse outcomes across an international cohort, and identify factors associated with a complete treatment response.

Methods

An international panel of 31 primary aldosteronism experts used the Delphi method to reach consensus on the definition of complete, partial, or absent biochemical and clinical outcomes of medical treatment of primary aldosteronism. Clinical data at baseline and 6–12 months post-treatment were collected from patients with primary aldosteronism who started targeted medical treatment between 2016 and 2021 at 28 participating centres.

Findings

Consensus was reached for defining complete, partial, or absent biochemical or clinical response. Of 1258 patients (with a mean age of 52 years [SD 11·5] and of whom 610 [48·5%] were female and 648 [51·5%] were male), 1057 (84·0%) had biochemical outcome data (559 [52·9%] had a complete biochemical response). The median daily dose of spironolactone was significantly higher for those with a complete biochemical response than for those without (40 mg [IQR 25−50] vs 25 mg [20−50]; p=0·011). Of the 1248 patients with clinical outcome data, 228 [18·3%] had a complete clinical response whereas 227 (18·2%) had an absent response. Patients with a complete clinical response were more likely than those with partial or absent clinical response to be women (OR 2·099, 95% CI 1·485–2·968; p<0·001), require lower doses of antihypertensive drugs at baseline (0·687, 0·603–0·782; p<0·001), and were less likely to have microalbuminuria or left ventricular hypertrophy (0·584, 0·391–0·873; p=0·009).

Interpretation

The Primary Aldosteronism Medical Treatment Outcome (PAMO) criteria represent an internationally developed outcome standard that can guide clinical practice and research into primary aldosteronism. Efforts to optimise treatment intensity and minimise factors associated with an absent treatment response are needed to improve patient outcomes.

Funding

None.

Translations

For the Chinese (simple), Chinese (complex), Japanese, Korean, German, French, Spanish, Dutch, Swedish, Slovenian, Polish, Italian and Russian translations of the abstract see Supplementary Materials section.

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原发性醛固酮增多症药物治疗后的结果：国际共识和对国际队列治疗反应的分析

背景：原发性醛固酮增多症可以通过药物治疗，但没有标准的方法来评估治疗结果。我们旨在制定评估原发性醛固酮增多症靶向药物治疗结果的标准，分析国际队列的结果，并确定与完全治疗反应相关的因素。方法一个由31名原发性醛固酮增多症专家组成的国际小组使用德尔菲法对原发性醛固酮增多症医学治疗的完全、部分或缺乏生化和临床结果的定义达成共识。从2016年至2021年在28个参与中心开始靶向治疗的原发性醛固酮增多症患者中收集基线和治疗后6-12个月的临床数据。对于完全、部分或不存在生化反应或临床反应的定义达成了共识。1258例患者（平均年龄52岁[SD 11.5]，其中女性610例（48.5%），男性648例（51.5%）），1057例（81.4%）有生化结局数据（559例（52.9%）有完全生化反应）。有完全生化反应的患者服用螺内酯的中位日剂量显著高于无生化反应的患者（40 mg [IQR 25−50]vs 25 mg[20−50]）；p = 0·011)。在1248例有临床结局数据的患者中，228例（18.3%）有完全的临床反应，而227例（18.2%）无反应。完全临床反应的患者比部分或无临床反应的患者更有可能是女性(or 2.099, 95% CI 1.485 - 1.968；P< 0.001)，在基线时需要较低剂量的抗高血压药物(0.687,0.603 - 0.782；P< 0.001)，且较少发生微量白蛋白尿或左心室肥厚(0.584,0.391 - 0.873；p = 0·009)。原发性醛固酮增多症医学治疗结果（PAMO）标准代表了国际上发展的结果标准，可以指导原发性醛固酮增多症的临床实践和研究。为了改善患者的预后，需要努力优化治疗强度和最小化与治疗反应缺失相关的因素。资金来源无。翻译摘要的中文（简单）、中文（复杂）、日语、韩语、德语、法语、西班牙语、荷兰语、瑞典语、斯洛文尼亚语、波兰语、意大利语和俄语翻译见补充资料部分。

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来源期刊

The Lancet Diabetes & Endocrinology ENDOCRINOLOGY & METABOLISM-

CiteScore

61.50

自引率

1.60%

发文量

371

期刊介绍： The Lancet Diabetes & Endocrinology, an independent journal with a global perspective and strong clinical focus, features original clinical research, expert reviews, news, and opinion pieces in each monthly issue. Covering topics like diabetes, obesity, nutrition, and more, the journal provides insights into clinical advances and practice-changing research worldwide. It welcomes original research advocating change or shedding light on clinical practice, as well as informative reviews on related topics, especially those with global health importance and relevance to low-income and middle-income countries. The journal publishes various content types, including Articles, Reviews, Comments, Correspondence, Health Policy, and Personal Views, along with Series and Commissions aiming to drive positive change in clinical practice and health policy in diabetes and endocrinology.