Evaluating the effects of adrenalectomy and mineralocorticoid receptor antagonist on cardiac remodeling and diastolic function in patients with aldosterone-producing adenoma.
Journal
Hypertension research : official journal of the Japanese Society of Hypertension
Journal Volume
48
Journal Issue
2
Start Page
529
End Page
539
ISSN
1348-4214
Date Issued
2025-02
Author(s)
Chang, Yu-Ching
Wu, Xue-Ming
Chen, Uei-Lin
Yang, Fang-Yu
Chang, Yi-Yao
Chen, Ying-Ying
Huang, Wei-Chieh
Ho, Chen-Hsun
Pan, Chien-Ting
Tsai, Yao-Chou
Wu, Che-Hsiung
Hu, Ya-Hui
Er, Leay-Kiaw
Lin, Po-Chih
Lee, Bo-Chiag
Abstract
Cardiac remodeling and diastolic dysfunction in patients with aldosterone-producing adenomas (APA) can be improved after adrenalectomy. However, the effect of mineralocorticoid receptor antagonist (MRA) treatment remains unclear. The aim of this study is to evaluate the effect of MRA on cardiac remodeling and diastolic dysfunction in patients with PA. We prospectively enrolled patients with APA from 1993 to 2023, who either received medical treatment with MRAs or underwent adrenalectomy. Biochemical characteristics and echocardiographic findings were collected at baseline and one year after treatment. Propensity score matching was conducted based on baseline biochemical characteristics, left ventricular mass index (LVMI), and diastolic function. A total of 467 APA patients were enrolled in the study. After propensity score matching, 159 patients who underwent adrenalectomy were matched with 159 patients who received MRAs. After therapy, patients who received MRAs showed significant improvement in diastolic function after one year of treatment but not LVMI. Compared to the MRA group, the adrenalectomy group had greater improvement in systolic blood pressure, plasma aldosterone concentration, plasma renin activity, aldosterone-to-renin ratio, and LVMI. In multivariable regression analysis, pretreatment echocardiographic values were significantly associated with changes in both LVMI and E/e', while the treatment strategy showed a significant association with changes in LVMI. Thus, one year after therapy, both adrenalectomy and MRA are effective in improving diastolic function in patients with APA. However, adrenalectomy is more effective than MRA treatment in reversing cardiac remodeling in patients with APA.
Subjects
Adrenalectomy
Aldosterone-producing adenoma
Diastolic dysfunction
Left ventricular remodeling
Mineralocorticoid receptor antagonist
SDGs
Type
journal article