SynthesisFrontiers in endocrinology2025
Primary aldosteronism: pharmacotherapy
Synthesis in Frontiers in endocrinology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Primary aldosteronism (PA) is one of major cause of resistant hypertension. This study compares the efficacy and safety of current treatments, including pharmacotherapy, adrenalectomy, and minimally invasive techniques, to guide clinical practice. Method: We systematically searched Embase, PubMed, Cochrane, Web of Science, CNKI, Wanfang, and VIP from inception to August 13, 2024, for randomized controlled trials and cohort studies involving adult patients with PA and hypertension. Reporting quality of the included studies was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the Newcastle-Ottawa Scale (NOS) for cohort studies. Data analysis was performed using R 4.3.3 and STATA 15.0. Results: This study included 17 articles involving 1,496 patients, of which 13 studies (76%) were conducted in China. Meta-analysis showed that for systolic blood pressure (SBP), unilateral total adrenalectomy and renal nerve denervation (TADR+RND) was most effective (WMD = -12.53, 95% Crl -15.18 to -9.90). For diastolic blood pressure (DBP), Partial adrenalectomy (PADR) (WMD = -9.31, 95% Crl -12.97 to -5.68). PADR also maintained serum potassium levels effectively (0.64, 95% Crl 0.52 to 0.75). Among pharmacological treatments, mineralocorticoid receptor antagonists and irbesartan (MRAs+IRB) had the greatest antihypertensive effect (SBP: WMD = -18.90, 95% Crl -29.20 to -8.55; DBP: WMD = -22.14, 95% Crl -31.81 to -12.50). Mineralocorticoid receptor antagonists did not significantly reduce plasma aldosterone concentration (PAC), consistent with their known feedback-related tendency to increase PAC. Conclusions: This study showed TADR + RND and MRAs + IRB had best efficacy in surgical and pharmacological treatments, respectively, but 76% of the included studies were conducted in China, which may affect the generalizability of the findings. Therefore, the results need further validation.
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