Cardiovascular risk in primary aldosteronism: A systematic review and meta-analysis

Area of Science:

• Cardiology
• Endocrinology
• Hypertension Research

Background:

• Hypertension is a major risk factor for cardiovascular and cerebrovascular events.
• Primary aldosteronism (PA) is an increasingly recognized cause of secondary hypertension.
• The specific impact of PA on cardiovascular and cerebrovascular (CCV) event risk compared to essential hypertension (EH) requires further elucidation.

Purpose of the Study:

• To evaluate the association between primary aldosteronism (PA) and the increased risk of cardiovascular and cerebrovascular (CCV) events in hypertensive patients.
• To compare the incidence of CCV events in patients with PA versus those with essential hypertension (EH).

Main Methods:

• A systematic literature search was conducted across PubMed, EmBase, and the Cochrane Central Register of Controlled Trials.
• Meta-analysis techniques, including calculation of risk ratios (RR) and mean differences (MD), were employed to assess outcomes.
• Key outcomes analyzed included stroke, coronary artery disease, left ventricular hypertrophy (LVH), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose, and urinary potassium levels.

Main Results:

• The analysis included 31 studies with 4546 PA patients and 52,284 EH patients.
• PA was significantly linked to a higher risk of stroke (RR=2.03), coronary artery disease (RR=1.67), and LVH (RR=1.54) compared to EH.
• PA patients exhibited significantly higher SBP (MD=4.14), DBP (MD=2.65), and urinary potassium levels, but no significant difference in blood glucose levels was observed.

Conclusions:

• Primary aldosteronism significantly increases the risk of cardiac and cerebrovascular complications.
• Patients diagnosed with PA may benefit from periodic cardiovascular and cerebrovascular risk assessments.
• These findings underscore the importance of screening for PA in hypertensive individuals at high risk for CCV events.