Long-Term Mortality for Patients of Primary Aldosteronism Compared With Essential Hypertension: A Systematic Review and Meta-Analysis

Zhe Meng, Zhe Dai, Kai Huang, Chang Xu, Yin-Gao Zhang, Hang Zheng, Tong-Zu Liu, Zhe Meng, Zhe Dai, Kai Huang, Chang Xu, Yin-Gao Zhang, Hang Zheng, Tong-Zu Liu

Abstract

Background: Consistent evidence have demonstrated that patients with primary aldosteronism (PA) have higher risk of cardiovascular events to patients with essential hypertension (EH). Whether the long-term risk of mortality for PA patients is higher than EH patients is unclear. We aim to compare the long-term mortality of patients with PA to patients with EH. Methods: We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for eligible studies from inception to 14 Nov 2018. We combined the relative risks (RR) of each included study by random-effect model. The amount of between study heterogeneity was measured by the I2 statistic. Results: We totally included six studies with cohort design, including 3,039 PA and 45,495 EH patients. The pooled RRs for patients with PA were 1.97 (95%CI: 1.33, 2.91; P = 0.0007) for a follow-up of 3 years, 0.96 (95%CI: 0.75, 1.23; P = 0.76) for 5 years, 0.86 (95%CI: 0.51, 1.46) for 7.5 years, and 0.95 (95%CI: 0.61, 1.48; P = 0.58) for 10 years. For patients with aldosterone-producing adenomas (APA), evidence of lower risk of long-term mortality was observed. Our sensitivity analysis suggested our results were stable. Conclusions: Current evidence supported a higher risk of mortality for patients with primary aldosteronism at 3 years compared to patients with essential hypertension, however this risk no longer sustains as the follow-up time increased to 5 or more years. Patients with aldosterone-producing adenomas may have lower long-term mortality rate than patients with essential hypertension due to the better recovery of adrenalectomy.

Keywords: essential hypertension; meta-analysis; mortality; primary aldosteronism; systematic review.

Copyright © 2020 Meng, Dai, Huang, Xu, Zhang, Zheng and Liu.

Figures

Figure 1
Figure 1
Flow plot of literature screen.
Figure 2
Figure 2
Comparison of patient with PA and EH of the risk of mortality at different follow-up times.
Figure 3
Figure 3
Comparison of patient with APA and EH of the risk of mortality at different follow-up times.
Figure 4
Figure 4
Comparison of patient with medical treated PA and EH of the risk of mortality at different follow-up times.
Figure 5
Figure 5
The absolute incidence of death of patient with PA and EH at different follow-up times.
Figure 6
Figure 6
Publication bias.

References

    1. Briet M, Schiffrin EL. Aldosterone: effects on the kidney and cardiovascular system. Nat Rev Nephrol. (2010) 6:261–73. 10.1038/nrneph.2010.30
    1. Fuller PJ, Young MJ. Mechanisms of mineralocorticoid action. Hypertension. (2005) 46:1227–35. 10.1161/01.HYP.0000193502.77417.17
    1. Morera J, Reznik Y. MANAGEMENT OF ENDOCRINE DISEASE: The role of confirmatory tests in the diagnosis of primary aldosteronism. Eur J Endocrinol. (2018) 180:R45–58. 10.1530/EJE-18-0704
    1. Hannemann A, Wallaschofski H. Prevalence of primary aldosteronism in patient's cohorts and in population-based studies–a review of the current literature. Horm Metab Res. (2012) 44:157–62. 10.1055/s-0031-1295438
    1. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. . The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. (2016) 101:1889–916. 10.1210/jc.2015-4061
    1. Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, Van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery. (2004) 136:1227–35. 10.1016/j.surg.2004.06.051
    1. Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, et al. . A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. (2006) 48:2293–300. 10.1016/j.jacc.2006.07.059
    1. Savard S, Amar L, Plouin PF, Steichen O. Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension. (2013) 62:331–6. 10.1161/HYPERTENSIONAHA.113.01060
    1. Mulatero P, Monticone S, Bertello C, Viola A, Tizzani D, Iannaccone A, et al. . Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab. (2013) 98:4826–33. 10.1210/jc.2013-2805
    1. Hannemann A, Meisinger C, Bidlingmaier M, Döring A, Thorand B, Heier M, et al. . Association of plasma aldosterone with the metabolic syndrome in two German populations. Eur J Endocrinol. (2011) 164:751–8. 10.1530/EJE-10-1074
    1. Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, et al. . Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. (2018) 6:41–50. 10.1016/S2213-8587(17)30319-4
    1. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. . Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA. (2000) 283:2008–12. 10.1001/jama.283.15.2008
    1. Higgins JPT, Altman DG, Sterne JAC. Chapter 8: assessing risk of bias in included studies. In: Higgins JPT, Green S. editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March, 2011). The Cochrane Collaboration (2011). Available online at: (accessed March 28, 2018).
    1. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analyses. Ottawa Hospital Research Institute; (2011). Available online at: (accessed November 26, 2018).
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. (2002) 21:1539–58. 10.1002/sim.1186
    1. Simmonds MC, Higgins JP, Stewart LA, Tierneyb JF, Clarke MJ, Thompson SG. Meta-analysis of individual patient data from randomized trials: a review of methods used in practice. Clin Trials. (2005) 2:209–17. 10.1191/1740774505cn087oa
    1. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. (2000) 56:455–63. 10.1111/j.0006-341X.2000.00455.x
    1. Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, et al. . Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med. (2008) 168:80–5. 10.1001/archinternmed.2007.33
    1. Reincke M, Fischer E, Gerum S, Merkle K, Schulz S, Pallauf A, et al. . Observational study mortality in treated primary aldosteronism: the German Conn's registry. Hypertension. (2012) 60:618–24. 10.1161/HYPERTENSIONAHA.112.197111
    1. Chan CK, Hu YH, Chen L, Chang CC, Lin YF, Lai TS, et al. . Risk of sepsis in patients with primary aldosteronism. Crit Care. (2018) 22:313. 10.1186/s13054-018-2239-y
    1. Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. (2018) 6:51–9. 10.1016/S2213-8587(17)30367-4
    1. Rossi GP, Maiolino G, Flego A, Belfiore A, Bernini G, Fabris B, et al. . Adrenalectomy lowers incident atrial fibrillation in primary aldosteronism patients at long term. Hypertension. (2018) 71:585–91. 10.1161/HYPERTENSIONAHA.117.10596
    1. Rossi GP, Cesari M, Cuspidi C, Maiolino G, Cicala MV, Bisogni V, et al. . Long-term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertension. (2013) 62:62–9. 10.1161/HYPERTENSIONAHA.113.01316
    1. Park KS, Kim JH, Yang YS, Hong AR, Lee DH, Moon MK, et al. . Outcomes analysis of surgical and medical treatments for patients with primary aldosteronism. Endocr J. (2017) 64:623–32. 10.1507/endocrj.EJ16-0530
    1. Iwakura Y, Morimoto R, Kudo M, Ono Y, Takase K, Seiji K, et al. . Predictors of decreasing glomerular filtration rate and prevalence of chronic kidney disease after treatment of primary aldosteronism: renal outcome of 213 cases. J Clin Endocrinol Metab. (2014) 99:1593–8. 10.1210/jc.2013-2180
    1. Muth A, Ragnarsson O, Johannsson G, Wängberg B. Systematic review of surgery and outcomes in patients with primary aldosteronism. Br J Surg. (2015) 102:307–17. 10.1002/bjs.9744
    1. Young WF, Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. (2018) 285:126–48. 10.1111/joim.12831
    1. Vilela LAP, Almeida MQ. Diagnosis and management of primary aldosteronism. Arch Endocrinol Metab. (2017) 61:305–12. 10.1590/2359-3997000000274

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa