TY - JOUR
T1 - Basal Plasma Aldosterone Concentration Predicts Therapeutic Outcomes in Primary Aldosteronism
AU - Saiki, Aya
AU - Otsuki, Michio
AU - Mukai, Kosuke
AU - Hayashi, Reiko
AU - Shimomura, Iichiro
AU - Kurihara, Isao
AU - Ichijo, Takamasa
AU - Takeda, Yoshiyu
AU - Katabami, Takuyuki
AU - Tsuiki, Mika
AU - Wada, Norio
AU - Ogawa, Yoshihiro
AU - Kawashima, Junji
AU - Sone, Masakatsu
AU - Inagaki, Nobuya
AU - Yoshimoto, Takanobu
AU - Okamoto, Ryuji
AU - Takahashi, Katsutoshi
AU - Kobayashi, Hiroki
AU - Tamura, Kouichi
AU - Kamemura, Kohei
AU - Yamamoto, Koichi
AU - Izawa, Shoichiro
AU - Kakutani, Miki
AU - Yamada, Masanobu
AU - Tanabe, Akiyo
AU - Naruse, Mitsuhide
N1 - Funding Information:
Financial Support: This study was supported by the Japan Agency for Medical Research and Development (#JP17ek0109112 and JP19ek0109352), the National Center for Global Health and Medicine, Japan (#27–1402 and 30–1008), and a Health Labour Sciences Research Grant (Nanchitou [Nan] – Ippan—046) from the Ministry of Health, Labor and Welfare, Japan.
Publisher Copyright:
© 2020 Oxford University Press. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Purpose: Normal basal plasma aldosterone concentration (PAC) reflects mild aldosterone excess compared to high basal PAC. We previously reported lower risk for cardiovascular and cerebrovascular events in patients with primary aldosteronism (PA) and normal basal PAC (nPA) than in those with high basal PAC (hPA). However, the differences in therapeutic outcomes between nPA and hPA are unclear. The aim of this multi-institutional, retrospective cohort study was to determine the clinical significance of nPA to therapeutic outcomes, including adrenalectomy (ADX) and treatment with mineralocorticoid receptor antagonists (MRAs). Methods: A total of 1146 patients with PA who were diagnosed and underwent adrenal venous sampling (AVS) between January 2006 and October 2016 were enrolled. The clinical parameters at baseline and after ADX or treatment with MRA were compared between the nPA and hPA groups. Results: Significantly higher rates of absent clinical success (36.6 vs. 21.9%, P = 0.01) and absent biochemical success (26.4 vs. 5.2%, P < 0.01) were found for the nPA group than for the hPA group, respectively. Logistic regression analysis identified baseline PAC as a significant independent predictor of absent clinical success of ADX and MRAs. Conclusions: Plasma aldosterone concentration at baseline was a significant and independent predictor of absent clinical success of ADX and MRA. Mineralocorticoid receptor antagonist treatment appeared to be a better therapeutic choice than ADX in the nPA group.
AB - Purpose: Normal basal plasma aldosterone concentration (PAC) reflects mild aldosterone excess compared to high basal PAC. We previously reported lower risk for cardiovascular and cerebrovascular events in patients with primary aldosteronism (PA) and normal basal PAC (nPA) than in those with high basal PAC (hPA). However, the differences in therapeutic outcomes between nPA and hPA are unclear. The aim of this multi-institutional, retrospective cohort study was to determine the clinical significance of nPA to therapeutic outcomes, including adrenalectomy (ADX) and treatment with mineralocorticoid receptor antagonists (MRAs). Methods: A total of 1146 patients with PA who were diagnosed and underwent adrenal venous sampling (AVS) between January 2006 and October 2016 were enrolled. The clinical parameters at baseline and after ADX or treatment with MRA were compared between the nPA and hPA groups. Results: Significantly higher rates of absent clinical success (36.6 vs. 21.9%, P = 0.01) and absent biochemical success (26.4 vs. 5.2%, P < 0.01) were found for the nPA group than for the hPA group, respectively. Logistic regression analysis identified baseline PAC as a significant independent predictor of absent clinical success of ADX and MRAs. Conclusions: Plasma aldosterone concentration at baseline was a significant and independent predictor of absent clinical success of ADX and MRA. Mineralocorticoid receptor antagonist treatment appeared to be a better therapeutic choice than ADX in the nPA group.
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U2 - 10.1210/JENDSO/BVAA011
DO - 10.1210/JENDSO/BVAA011
M3 - Article
AN - SCOPUS:85087146597
SN - 2472-1972
VL - 4
SP - 1
EP - 12
JO - Journal of the Endocrine Society
JF - Journal of the Endocrine Society
IS - 4
ER -
