Adrenalectomy versus esaxerenone: comparison of vascular benefits in patients with aldosterone-producing adenoma

The efficacy of adrenalectomy compared to the efficacy of treatment with esaxerenone in improving vascular function and arterial stiffness in patients with aldosterone-producing adenoma (APA) remains uncertain. The aim of this study was to determine the effects of esaxerenone on blood pressure, serum potassium, vascular function and arterial stiffness in patients with APA and to compare the effects of adrenalectomy and treatment with esaxerenone on vascular function and arterial stiffness as surrogate markers of cardiovascular events.

Flow-mediated vasodilation (FMD), nitroglycerine-induced vasodilation (NID), and brachial-ankle pulse wave velocity (baPWV) were measured to assess vascular function and arterial stiffness before and after 3-month treatment with esaxerenone and at 3 months after adrenalectomy in 20 patients with APA.

FMD, NID, and baPWV after treatment with esaxerenone were significantly better than those before treatment with esaxerenone. FMD, NID, and baPWV after adrenalectomy were significantly better than those before treatment with esaxerenone. NID after adrenalectomy was significantly higher than that after treatment with esaxerenone (14.9 ± 4.8% vs. 13.0 ± 4.6%, P = 0.03). The changes in FMD, NID, and baPWV after adrenalectomy were significantly correlated with the changes in plasma aldosterone concentration.

Compared with esaxerenone treatment, adrenalectomy provided more favorable improvements in vascular function and arterial stiffness in patients with APA. Nevertheless, esaxerenone also improved blood pressure, serum potassium levels, vascular function, and arterial stiffness, suggesting that it may be a beneficial treatment option for patients with APA who are inoperable or refuse surgery.