Adrenalectomy Lowers Incident Atrial Fibrillation in Primary Aldosteronism Patients at Long Term


Primary aldosteronism (PA) causes cardiovascular damage in excess to the blood pressure elevation, but there are no prospective studies proving a worse long-term prognosis in adrenalectomized and medically treated patients. We have, therefore, assessed the outcome of PA patients according to treatment mode in the PAPY study (Primary Aldosteronism Prevalence in Hypertension) patients, 88.8% of whom were optimally treated patients with primary (essential) hypertension (PH), and the rest had PA and were assigned to medical therapy (6.4%) or adrenalectomy (4.8%). Total mortality was the primary end point; secondary end points were cardiovascular death, major adverse cardiovascular events, including atrial fibrillation, and total cardiovascular events. By showing that during a long-term follow-up adrenalectomized aldosterone-producing adenoma patients have a similar long-term outcome of optimally treated PH patients, whereas, at variance, medically treated PA patients remain at a higher risk of atrial fibrillation, this large prospective study emphasizes the importance of an early identification of PA patients who need adrenalectomy as a key measure to prevent incident atrial fibrillation.

Authors: Gian Paolo Rossi, Giuseppe Maiolino, Alberto Flego, Anna Belfiore, Giampaolo Bernini, Bruno Fabris, Claudio Ferri, Gilberta Giacchetti, Claudio Letizia, Mauro Maccario, Francesca Mallamaci, Maria Lorenza Muiesan, Massimo Mannelli, Aurelio Negro, Gaetana Palumbo, Gabriele Parenti, Ermanno Rossi, Franco Mantero, A. Semplicini, C. Ganzaroli, A.C. Pessina, Vanessa Ronconi, Marco Boscaro, Angelica Moretti, Giovambattista Desideri, Giuseppe Andronico, Damiano Rizzoni, Enzo Porteri, Chiara Caliumi, Ezio Ghigo, and Carmine Zoccali
Keywords: surgical vs medical treatment, atrial fibrillation, long-term cardiovascular risk
DOI Number: 10.1161/HYPERTENSIONAHA.117.10596      Publication Year: 2018

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