Implication of MR Activity in Posttreatment Arterial Stiffness Reversal in Patients With Primary Aldosteronism

Autor: Zheng-Wei Chen, Chien-Ting Pan, Che-Wei Liao, Cheng-Hsuan Tsai, Yi-Yao Chang, Chin-Chen Chang, Bo-Ching Lee, Yu-Wei Chiu, Wei-Chieh Huang, Shuo-Meng Wang, Ching-Chu Lu, Jeff S Chueh, Vin-Cent Wu, Chi-Sheng Hung, Yen-Hung Lin
Rok vydání: 2022
Předmět:
Zdroj: The Journal of Clinical Endocrinology & Metabolism. 108:624-632
ISSN: 1945-7197
0021-972X
DOI: 10.1210/clinem/dgac649
Popis: ContextPrimary aldosteronism (PA) patients have a higher degree of arterial stiffness, which can be reversed after adrenalectomy.ObjectiveWe aimed to compare the reversal of arterial stiffness between surgically and medically treated PA patients and to identify the predictors of effective medical treatment.MethodsWe prospectively enrolled 445 PA patients and collected data on baseline clinical characteristics, biochemistry, blood pressure, and pulse wave velocity (PWV) before treatment and 12 months after treatment. In the mineralocorticoid receptor antagonist (MRA)-treated patients, the relationship between the change in PWV after 1 year (ΔPWV) and posttreatment renin activity was explored using the restricted cubic spline (RCS) method.ResultsOf the 445 enrolled PA patients, 255 received adrenalectomy (group 1) and 190 received MRAs. In the RCS model, posttreatment plasma renin activity (PRA) 1.5 ng/mL/h was the best cutoff value. Therefore, we divided the MRA-treated patients into 2 groups: those with suppressed PRA (< 1.5 ng/mL/h, group 2), and those with unsuppressed PRA (≥ 1.5 ng/mL/h, group 3). Only group 1 and group 3 patients had a statistically significant improvement in PWV after treatment (both P < .001), whereas no significant improvement was noted in group 2 after treatment (P = .151). In analysis of variance and post hoc analysis, group 2 had a significantly lower ΔPWV than group 1 (P = .007) and group 3 (P = .031). Multivariable regression analysis of the MRA-treated PA patients identified log-transformed posttreatment PRA, age, and baseline PWV as independent factors correlated with ΔPWV.ConclusionThe reversal of arterial stiffness was found in PA patients receiving adrenalectomy and in medically treated PA patients with unsuppressed PRA.
Databáze: OpenAIRE
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