Author(s)

Junchi Cheng, Ruohan Ma, Ruohan Dai, Jinxin Ran, Bo Wang^*

The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

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 < 0.05). 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 < 0.05). In 2 studies, the surgical treatment of plasma aldosterone concentration (PAC) drop degree is superior to drug therapy (Mean difference IV: —12.63, P < 0.05), and blood pressure to improve the degree of surgery and drug treatment has no obvious difference. 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.

Primary Aldosteronism, Adrenalectomy, Mineralocorticoid Receptor Antagonist, Left Ventricular Mass Fraction, Ventricular Septal Thickness

Cheng, J. , Ma, R. , Dai, R. , Ran, J. and Wang, B. (2022) Comparison of Cardiac Structural Improvement in Patients with Primary Aldosteronism after Surgical Therapy and Drug Therapy: A Meta-Analysis. Open Journal of Endocrine and Metabolic Diseases, 12, 283-295. doi: 10.4236/ojemd.2022.1212021.