Primary Aldosteronism and Long-Term Cardiovascular Complications: Comparison of Medical Versus Surgical Treatment

The study aims to evaluate the long-term incidence of cardiovascular events (CVE) and compare the effectiveness of medical and surgical interventions using a combined cardiovascular endpoint in individuals diagnosed with primary aldosteronism (PA). The authors carried out a multicentric, retrospective study in Marseille on a total of 106 inpatients divided into two samples with biologically proven primary aldosteronism, of whom 55 underwent surgical treatment and 51 received medical therapy between January 2014 and December 2022. The mean age of the sample was 53 years. Over a 54-month follow-up period, five patients in the medical group (10.64%) and three in the surgical group (5.45%) experienced a CVE (p = 0.46). Although the difference was not statistically significant, the surgical group had more cardiovascular morbidity at baseline. At the end of the follow-up, the surgical group demonstrated a significant reduction in blood pressure (BP) (mean 126/74 mmHg) compared to the medical group (mean 136/81 mmHg) (p = 0.02), with a significantly lower number of antihypertensive medications (1.23 ± 1.5 vs. 2.83 ± 1.8, p < 0.01). Additionally, the surgical group had a significantly higher serum potassium level at the end of follow-up despite similar potassium supplementation. The long-term incidence of CVE in PA did not significantly differ between medical and surgical treatment. However, there appears to be a trend toward reduced CVE over the long term in surgically treated patients who had excess cardiovascular morbidity at baseline. In addition, surgical treatment significantly improved BP control, with patients requiring fewer and demonstrating better serum potassium regulation.