Endocrine Abstracts

Objectives: Along with better recognition of the role of primary aldosteronism (PA) in increasing cardiovascular risk and the potential of targeted therapy for PA, the long-term mortality according to different treatments are poorly understood.

Methods: We investigated PA patients using the validated algorithms between 1999 and 2011. Their data were extracted from the whole claims of the Taiwan National Health Insurance. We used Cox regression with time-varying covariates to adjust for subsequent adrenalectomy, mineralocorticoid receptor antagonist (MRA) and potassium prescription after diagnosis.

Results: Among the 3362 PA patients who were identified, 846 patients received adrenalectomy and 452 patients expired. The incidence rate of death was 23.4 per 1000 person-years during a mean follow-up of 5.75 years. In time varying Cox model, patients who received adrenalectomy were associated with decreased risk of mortality (hazard ratio (HR) 0.32), independent of the effects of potassium supplement (HR 2.39), and age (HR, 1.09). Patients who received MRA after diagnosis did not relate to mortality risk. An additional analysis was conducted to show the defined daily dose (DDD) of MRA between 0.2 and 1.3 has the lowest impact on mortality.

Conclusion: In national wide population claim data, we provide the first time that PA patients with adrenalectomy could improve long-term risk of death, while MRA did only within appropriate prescription. The result suggests that early diagnosis and target therapy may warrant PA patients care. The findings made in the present association study need to be confirmed by randomized controlled trials to prove the observed beneficial effect of adrenalectomy on PA mortality.