Comparative Outcomes of Adrenalectomy, Mineralocorticoid Receptor Antagonist, and Percutaneous Adrenal Ablation for Primary Aldosteronism: A Systematic Review and Network Meta-Analysis.

IF 3.1 3区医学 Q2 PERIPHERAL VASCULAR DISEASE

American Journal of Hypertension Pub Date : 2025-08-14 DOI:10.1093/ajh/hpaf029

Liyuan Yuan, Xinyi Li, Fang Sun, Yi Tang, Wuhao Wang, Wei Liu, Xiaona Sun, Yushuang Luo, Xiaona Bu, Zongshi Lu, Daoyan Liu, Qiang Li, Zhiming Zhu

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引用次数: 0

Abstract

Background: Percutaneous adrenal ablation (PAA) is an effective and safe therapy for treating patients with primary aldosteronism (PA). However, its effectiveness in comparison to that of adrenalectomy (ADX) and mineralocorticoid receptor antagonists (MRAs) remains unclear.

Methods: Databases were searched including PubMed, Embase, and The Cochrane Library. Studies included patients with PA who received two of three different treatments (ADX, MRAs, or PAA) and reported our interested outcomes, including blood pressure, serum potassium, and the aldosterone-to-renin ratio (ARR).

Results: In a total of 10,681 patients from 47 studies were identified. Both ADX and PAA showed superior clinical success (systolic blood pressure (BP): ADX: -4.69 (-6.4, -2.95), PAA: -3.96 (-9.05, 0.99); diastolic BP: ADX: -3.14 (-4.55, -1.85), PAA: -2.99 (-6.96, 0.98)) compared with MRAs. According to the Bayesian ranking curves (surface under the cumulative ranking values), ADX ranked first for all outcomes of interest (systolic BP: 81.02%, diastolic BP: 76.95%, serum potassium: 96.55%, and ARR: 88.03%), while PAA ranked second for all outcomes (systolic BP: 65.94%, diastolic BP: 69.66%, serum potassium: 50%, and ARR: 45.14%).

Conclusions: The findings of this network meta-analysis suggest that PAA could be an alternative treatment for patients with PA who are unable to opt for surgery or MRA therapy, and its clinical and biochemical success falls between those of ADX and MRAs.

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肾上腺切除术、矿皮质激素受体拮抗剂和经皮肾上腺消融治疗原发性醛固酮增多症的比较结果：一项系统综述和网络荟萃分析。

背景：经皮肾上腺消融（PAA）是治疗原发性醛固酮增多症（PA）的一种安全有效的治疗方法。然而，与肾上腺切除术（ADX）和矿皮质激素受体拮抗剂（MRAs）相比，其有效性尚不清楚。方法：检索数据库包括：Pubmed、Embase和Cochrane Library。如果PA患者接受了三种不同治疗（ADX、MRAs或PAA）中的两种，并报告了我们感兴趣的结果，包括血压、血清钾和醛固酮-肾素比（ARR），则纳入研究。结果：47项研究共纳入10681例患者。ADX和PAA均有较好的临床效果(收缩压：ADX: -4.69 [-6.4, -2.95], PAA: -3.96 [-9.05, 0.99]；舒张压：ADX: -3.14 [-4.55, -1.85], PAA: -2.99[-6.96, 0.98])。根据贝叶斯排序曲线（SUCRA值），ADX在所有指标中排名第一（收缩压：81.02%，舒张压：76.95%，血钾：96.55%,ARR: 88.03%）， PAA在所有指标中排名第二（收缩压：65.94%，舒张压：69.66%，血钾：50%，ARR: 45.14%）。结论：本网络荟萃分析的结果表明，对于无法选择手术或MRA治疗的PA患者，PAA可能是一种替代治疗方法，其临床和生化成功率介于ADX和MRA之间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Hypertension 医学-外周血管病

CiteScore

6.90

自引率

6.20%

发文量

144

审稿时长

3-8 weeks

期刊介绍： The American Journal of Hypertension is a monthly, peer-reviewed journal that provides a forum for scientific inquiry of the highest standards in the field of hypertension and related cardiovascular disease. The journal publishes high-quality original research and review articles on basic sciences, molecular biology, clinical and experimental hypertension, cardiology, epidemiology, pediatric hypertension, endocrinology, neurophysiology, and nephrology.