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Adrenalectomy Versus Medical Therapy in Primary Aldosteronism: A Meta-Analysis of Long-Term Cardiac Remodeling and

Luigi Marzano1, Francesca Zoccatelli1, Francesca Pizzolo1

  • 1Department of Medicine, Unit of Internal Medicine B, University of Verona School of Medicine, Azienda Ospedaliera Universitaria Integrata Verona, Italy.

Hypertension (Dallas, Tex. : 1979)
|June 25, 2025
PubMed

Insights

Adrenalectomy significantly reduces left ventricular mass (LVM) and hypertrophy in primary aldosteronism (PA) more effectively than mineralocorticoid receptor antagonists (MRAs). This supports adrenalectomy as a first-line treatment for unilateral PA.

Area of Science:

  • Cardiology
  • Endocrinology
  • Hypertension Research

Background:

  • Primary aldosteronism (PA) is a common, curable cause of secondary hypertension.
  • PA significantly increases left ventricular mass (LVM) and cardiovascular risk.
  • The comparative long-term efficacy of adrenalectomy versus mineralocorticoid receptor antagonists (MRAs) in reversing cardiac changes is debated.

Purpose of the Study:

  • To systematically compare the long-term efficacy of adrenalectomy and MRAs in reversing cardiac structural changes in patients with PA.
  • To evaluate the impact of these treatments on left ventricular mass (LVM) and hypertrophy.

Main Methods:

  • Systematic search of MEDLINE and Embase for clinical trials up to November 22, 2024, with ≥6 months follow-up.
  • Inclusion of prospective and retrospective studies reporting LVM changes in PA patients treated with adrenalectomy or MRAs.
  • Independent data extraction and risk-of-bias assessment; primary outcome was indexed LVM reduction.

Main Results:

  • Analysis of 17 studies with 1696 patients (49% adrenalectomy, 51% MRA therapy).
  • Adrenalectomy resulted in significantly greater indexed LVM reduction (-3.5%) and a 32% reduction in left ventricular hypertrophy risk ratio compared to MRAs (19% reduction).
  • Shorter hypertension duration predicted greater LVM regression post-adrenalectomy; high sodium intake attenuated MRA effects. Left ventricular ejection fraction improved modestly after adrenalectomy.

Conclusions:

  • Adrenalectomy offers superior long-term regression of LVM and left ventricular hypertrophy in PA compared to MRAs.
  • These findings support adrenalectomy as the preferred first-line treatment for unilateral PA.
  • Future research should investigate novel MRAs and aldosterone synthase inhibitors for optimizing cardiac remodeling.
Abstract

Keywords:
adrenalectomyhyperaldosteronismhypertensionhypertrophymeta-analysismineralocorticoids

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