Therapeutic Outcomes with Surgical and Medical Management of Primary Aldosteronism.
Heather WachtelDouglas L FrakerPublished in: Current cardiology reports (2021)
PA causes cardiovascular dysfunction in excess of degree of hypertension. Adrenalectomy demonstrates a therapeutic advantage over mineralocorticoid antagonist (MRA) therapy, after controlling for degree of hypertension and subtype of PA. Higher rates of atrial fibrillation, heart failure, stroke, and incidence of chronic kidney disease are observed in subjects treated with MRAs than in subjects treated with adrenalectomy. The therapeutic benefit of surgery may reflect definitive resolution of excess aldosterone. Complete mineralocorticoid blockade may achieve similar benefit to adrenalectomy. Adrenalectomy is the most effective treatment for unilateral PA. Biomarkers for MRA therapy might inform optimal medical therapy of bilateral adrenal hyperplasia.
Keyphrases
- atrial fibrillation
- heart failure
- chronic kidney disease
- blood pressure
- healthcare
- minimally invasive
- magnetic resonance imaging
- stem cells
- contrast enhanced
- risk factors
- oxidative stress
- left ventricular
- radiation therapy
- adipose tissue
- end stage renal disease
- percutaneous coronary intervention
- metabolic syndrome
- angiotensin ii
- computed tomography
- venous thromboembolism
- single molecule
- coronary artery bypass
- oral anticoagulants
- coronary artery disease
- insulin resistance
- brain injury
- rectal cancer