Paola Parra Ramírez, Patricia Martín Rojas-Marcos, Miguel Paja Fano, Margarita González-Boillos, Eider Pascual-Corrales, Ana María García Cano, Jorge Gabriel Ruiz-Sanchez, Almudena Vicente Delgado, Emilia Gómez Hoyos, Rui Ferreira, Iñigo García Sanz, Mònica Recasens Sala, Rebeca Barahona San Millan, María José Picón César, Patricia Díaz Guardiola, Carolina M Perdomo, Laura Manjón-Miguélez, Ángel Rebollo Román, Cristina Robles Lázaro, Manuel Morales-Ruiz, María Calatayud, Simone Andree Furio Collao, Diego Meneses, Miguel Antonio Sampedro-Nuñez, Elena Mena Ribas, Alicia Sanmartín Sánchez, Cesar Gonzalvo Diaz, Cristina Lamas, Raquel Guerrero-Vázquez, María Del Castillo Tous, Joaquín Serrano Gotarredona, Theodora Michalopoulou Alevras, Susana Tenés Rodrigo, Ricardo Roa Chamorro, Fernando Jaen Aguila, Eva María Moya Mateo, Felicia A Hanzu, Marta Araujo-Castro
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Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy has been reported to reduce the cardiometabolic risk. However, the cardiovascular benefit could depend on plasma renin levels in patients on MRA.</p><p><strong>Aim: </strong>To compare the development of cardiovascular, renal and metabolic complications between medically treated patients with PA and those who underwent adrenalectomy, taking the renin status during MRA treatment into account.</p><p><strong>Methods: </strong>A multicenter retrospective study (SPAIN-ALDO Register) of patients with PA treated at 35 Spanish tertiary hospitals. Patients on MRA were divided into two groups based on renin suppression (n = 90) or non-suppression (n = 70). Both groups were also compared to unilateral PA patients (n = 275) who achieved biochemical cure with adrenalectomy.</p><p><strong>Results: </strong>Adrenalectomized patients were younger, had higher plasma aldosterone concentration, and lower potassium levels than MRA group. Patients on MRA had similar baseline characteristics when stratified into treatment groups with suppressed and unsuppressed renin. 97 (55.1%) of 176 patients without comorbidities at diagnosis, developed at least one comorbidity during follow-up (median 12 months vs. 12.5 months' follow-up after starting MRA and surgery, respectively). Surgery group had a lower risk of developing new cardiovascular events (HR 0.40 [95% CI 0.18-0.90]) than MRA group. Surgical treatment improved glycemic and blood pressure control, increased serum potassium levels, and required fewer antihypertensive drugs than medical treatment. However, there were no differences in the cardiometabolic profile or the incidence of new comorbidities between the groups with suppressed and unsuppressed renin levels (HR 0.95 [95% CI 0.52-1.73]).</p><p><strong>Conclusion: </strong>Cardiovascular, renal, and metabolic events were comparable in MRA patients with unsuppressed and suppressed renin. Effective surgical treatment of PA was associated with a decreased incidence of new cardiovascular events when compared to MRA therapy.</p>","PeriodicalId":12890,"journal":{"name":"High Blood Pressure & Cardiovascular Prevention","volume":" ","pages":"43-53"},"PeriodicalIF":3.1000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Renin as a Biomarker to Guide Medical Treatment in Primary Aldosteronism Patients. 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引用次数: 0
摘要
简介原发性醛固酮增多症（PA）与多种心脏代谢合并症有关。有报道称，使用矿皮质激素受体拮抗剂（MRA）或肾上腺切除术进行特定治疗可降低心脏代谢风险。目的：比较接受药物治疗的 PA 患者与接受肾上腺切除术的患者之间心血管、肾脏和代谢并发症的发生情况，同时考虑到 MRA 治疗期间的肾素状态：一项多中心回顾性研究（SPAIN-ALDO 登记），研究对象为在西班牙 35 家三级医院接受治疗的 PA 患者。根据肾素抑制（90 人）或非抑制（70 人）将接受 MRA 治疗的患者分为两组。两组患者还与通过肾上腺切除术获得生化治愈的单侧 PA 患者（n = 275）进行了比较：与 MRA 组相比，肾上腺切除患者更年轻，血浆醛固酮浓度更高，血钾水平更低。将接受 MRA 的患者分为肾素受抑制组和肾素未受抑制组时，其基线特征相似。在诊断时无合并症的 176 名患者中，有 97 人（55.1%）在随访期间至少出现了一种合并症（开始 MRA 和手术后的随访时间中位数分别为 12 个月和 12.5 个月）。手术组发生新的心血管事件的风险（HR 0.40 [95% CI 0.18-0.90]）低于 MRA 组。与药物治疗相比，手术治疗改善了血糖和血压控制，提高了血清钾水平，所需降压药物也更少。然而，肾素水平受抑制组和未受抑制组在心脏代谢概况或新合并症发生率方面没有差异（HR 0.95 [95% CI 0.52-1.73]）：结论：在肾素水平未受抑制和受抑制的 MRA 患者中，心血管、肾脏和代谢事件的发生率相当。与 MRA 治疗相比，有效的 PA 手术治疗可降低新发心血管事件的发生率。
Renin as a Biomarker to Guide Medical Treatment in Primary Aldosteronism Patients. Findings from the SPAIN-ALDO Registry.
Introduction: Primary aldosteronism (PA) is associated with several cardiometabolic comorbidities. Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy has been reported to reduce the cardiometabolic risk. However, the cardiovascular benefit could depend on plasma renin levels in patients on MRA.
Aim: To compare the development of cardiovascular, renal and metabolic complications between medically treated patients with PA and those who underwent adrenalectomy, taking the renin status during MRA treatment into account.
Methods: A multicenter retrospective study (SPAIN-ALDO Register) of patients with PA treated at 35 Spanish tertiary hospitals. Patients on MRA were divided into two groups based on renin suppression (n = 90) or non-suppression (n = 70). Both groups were also compared to unilateral PA patients (n = 275) who achieved biochemical cure with adrenalectomy.
Results: Adrenalectomized patients were younger, had higher plasma aldosterone concentration, and lower potassium levels than MRA group. Patients on MRA had similar baseline characteristics when stratified into treatment groups with suppressed and unsuppressed renin. 97 (55.1%) of 176 patients without comorbidities at diagnosis, developed at least one comorbidity during follow-up (median 12 months vs. 12.5 months' follow-up after starting MRA and surgery, respectively). Surgery group had a lower risk of developing new cardiovascular events (HR 0.40 [95% CI 0.18-0.90]) than MRA group. Surgical treatment improved glycemic and blood pressure control, increased serum potassium levels, and required fewer antihypertensive drugs than medical treatment. However, there were no differences in the cardiometabolic profile or the incidence of new comorbidities between the groups with suppressed and unsuppressed renin levels (HR 0.95 [95% CI 0.52-1.73]).
Conclusion: Cardiovascular, renal, and metabolic events were comparable in MRA patients with unsuppressed and suppressed renin. Effective surgical treatment of PA was associated with a decreased incidence of new cardiovascular events when compared to MRA therapy.
期刊介绍：
High Blood Pressure & Cardiovascular Prevention promotes knowledge, update and discussion in the field of hypertension and cardiovascular disease prevention, by providing a regular programme of independent review articles covering key aspects of the management of hypertension and cardiovascular diseases. The journal includes: Invited ''State of the Art'' reviews. Expert commentaries on guidelines, major trials, technical advances.Presentation of new intervention trials design.''Pros and Cons'' or round tables on controversial issues.Statements on guidelines from hypertension and cardiovascular scientific societies.Socio-economic issues.Cost/benefit in prevention of cardiovascular diseases.Monitoring of healthcare systems.News and views from the Italian Society of Hypertension (including abstracts).All manuscripts are subject to peer review by international experts. Letters to the editor are welcomed and will be considered for publication.
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