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Published on: September 15, 2017
A Comparison of Adrenalectomy and Eplerenone on Vascular Function in Patients with Aldosterone-producing Adenoma
Shinji Kishimoto1, Kenji Oki2, Tatsuya Maruhashi3
1Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Context:
It remains unclear whether adrenalectomy has more beneficial effects than treatment with a mineralocorticoid receptor antagonist on vascular function in patients with aldosterone-producing adenoma (APA).
Objective:
The aim of this study was to compare the effects of adrenalectomy and treatment with eplerenone on vascular function in patients with APA.
Design, Setting, And Patients:
Flow-mediated vasodilation (FMD), as an index of endothelium-dependent vasodilation, and nitroglycerine-induced vasodilation (NID), as an index of endothelium-independent vasodilation, were measured to assess vascular function before and after a 3-month treatment with eplerenone and at 3 months after adrenalectomy in 23 patients with APA.
Results:
Flow-mediated vasodilation and NID after adrenalectomy were significantly higher than those before treatment with eplerenone (5.4 ± 2.6% vs 2.7 ± 1.9% and 14.8 ± 4.7% vs 9.6 ± 4.6%, P < 0.01, respectively) and those after treatment with eplerenone (5.4 ± 2.6% vs 3.1 ± 2.3% and 14.8 ± 4.7% vs 11.0 ± 5.3%, P < 0.01 and P = 0.03, respectively), while treatment with eplerenone did not alter FMD and NID compared with those before treatment with eplerenone. After adrenalectomy, the increase in FMD and NID were significantly correlated with a decrease in plasma aldosterone concentration and a decrease in the aldosterone-renin ratio. There were no significant relationships between FMD and changes in other parameters or between NID and changes in other parameters.
Conclusions:
Adrenalectomy, but not treatment with eplerenone, improved vascular function in patients with APA. Adrenalectomy may be more effective than treatment with eplerenone for reducing the incidence of future cardiovascular events in patients with APA. Clinical Trial Information: URL for the clinical trial: http://UMIN; Registration Number for the clinical trial: UMIN000003409.
Insights
Adrenalectomy significantly improved vascular function in patients with aldosterone-producing adenoma (APA), unlike eplerenone treatment. This suggests adrenalectomy may be more effective in preventing future cardiovascular events in APA patients.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Vascular Biology
Background:
- Aldosterone-producing adenoma (APA) poses risks to vascular health.
- The comparative efficacy of adrenalectomy versus mineralocorticoid receptor antagonists (MRAs) on vascular function in APA patients remains unclear.
Purpose of the Study:
- To compare the effects of adrenalectomy and eplerenone (an MRA) on vascular function in patients with APA.
Main Methods:
- Vascular function was assessed using flow-mediated vasodilation (FMD) and nitroglycerine-induced vasodilation (NID).
- Measurements were taken before and after 3 months of eplerenone treatment, and 3 months post-adrenalectomy in 23 APA patients.
Main Results:
- Adrenalectomy significantly improved both FMD and NID compared to pre-treatment and post-eplerenone levels (P < 0.01).
- Eplerenone treatment did not significantly alter FMD or NID compared to baseline.
- Improvements in FMD and NID after adrenalectomy correlated with decreased plasma aldosterone and aldosterone-renin ratio.
Conclusions:
- Adrenalectomy, but not eplerenone, enhanced vascular function in APA patients.
- Adrenalectomy may offer superior protection against cardiovascular events compared to eplerenone in this population.
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