TITLE:
Comparison of Cardiac Structural Improvement in Patients with Primary Aldosteronism after Surgical Therapy and Drug Therapy: A Meta-Analysis
AUTHORS:
Junchi Cheng, Ruohan Ma, Ruohan Dai, Jinxin Ran, Bo Wang
KEYWORDS:
Primary Aldosteronism, Adrenalectomy, Mineralocorticoid Receptor Antagonist, Left Ventricular Mass Fraction, Ventricular Septal Thickness
JOURNAL NAME:
Open Journal of Endocrine and Metabolic Diseases,
Vol.12 No.12,
December
30,
2022
ABSTRACT: Background: At present, in clinical practice, patients with primary
hyperaldosteronism (PA) are mainly treated by surgery or medical drugs
(spironolactone/spironolactone, epridone, etc.). Some studies show that the
left ventricular hypertrophy of patients can be significantly improved after
treatment. However, at present, the relevant research is very limited, and
there is still controversy on the improvement of cardiac structure and function
between the two treatment methods. No reliable conclusions have been drawn. Objective: We conducted
this meta-analysis to compare the improvement of cardiac structure of patients
after surgical treatment and drug treatment, so as to clarify the efficacy of
surgical treatment and drug treatment for PA patients. Methods: In order
to examine the cardiac color ultrasound data of PA patients receiving surgical
treatment and drug therapy (spironolactone, antisterone), randomized or
observational studies were searched through Pubmed, Cochrane Library, and
Embase. Meta-analysis was then carried out on the comprehensive and individual
outcomes. The ROINBS-I scale is utilized to assess the offset risk of study
inclusion. Outcomes: A total of nine studies involving 799 patients with
PA into meta analysis, according to the results of the surgery in the treatment
of patients with PA, left ventricular mass index (LVMI) changes in value (drop
range) is significantly higher than drug therapy (Mean difference IV: —2.32,
P In 6
studies, after surgical treatment of interventricular septal thickness (IVSD), changes in value (drop
range) are also higher than drug therapy (Mean difference IV: —0.35, P In 2 studies, the surgical
treatment of plasma aldosterone concentration (PAC) drop degree is superior to
drug therapy (Mean difference IV: —12.63, P Conclusions: This meta-analysis result confirmed that after medical and surgical treatment
of PA can obviously improve the patient’s blood pressure, and no difference between the two
treatments. But for the heart structure improvement, including left ventricular
hypertrophy and interventricular septum thickness, surgical treatment effect is
significantly better than the medicine treatment, so the adrenalectomy can be
used as unilateral PA optimal choice of treatment.