New-Onset Atrial Fibrillation in Patients With Primary Aldosteronism Receiving Different Treatment Strategies: Systematic Review and Pooled Analysis of Three Studies.

Cheng-Hsuan Tsai,Po-Chin Lee,Yi-Yao Chang,Chien-Ting Pan,Che-Wei Liao,Chi-Sheng Hung,Zheng-Wei Chen,Yen-Hung Lin,Ya-Li Chen,Yu-Wei Chiu,Chin-Chen Chang,Yen-Tin Lin

doi:10.3389/fendo.2021.646933

Abstract

BackgroundPrimary aldosteronism (PA) is a common cause of secondary hypertension and associated with higher incidence of new-onset atrial fibrillation (NOAF). However, the effects of surgical or medical therapies on preventing NOAF in PA patents remain unclear. The aim of this meta-analysis study was to assess the risk of NOAF among PA patients receiving mineralocorticoid receptor antagonist (MRA) treatment, PA patients receiving adrenalectomy, and patients with essential hypertension.MethodsWe performed the meta-analysis of the randomized or observational studies that investigated the incidence rate of NOAF in PA patients receiving MRA treatment versus PA patients receiving adrenalectomy from database inception until December 01, 2020 which were identified from PubMed, Embase, and Cochrane Library.ResultsA total of 172 related studies were reviewed, of which three fulfilled the inclusion criteria, including a total of 2,705 PA patients. The results of meta-analysis demonstrated a higher incidence of NOAF among the PA patients receiving MRA treatment compared to the PA patients receiving adrenalectomy (pooled odds ratio [OR]: 2.83, 95% confidence interval [CI]: 1.76–4.57 in the random effects model, I 2 = 0%). The pooled OR for the PA patients receiving MRA treatment compared to the patients with essential hypertension was 1.91 (95% CI: 1.11–3.28). The pooled OR for the PA patients receiving adrenalectomy compared to the patients with essential hypertension was 0.70 (95% CI: 0.28–1.79).ConclusionCompared to the essential hypertension patients and the PA patients receiving adrenalectomy, the patients with PA receiving MRA treatment had a higher risk of NOAF.Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021222022.

Highlights

Primary aldosteronism (PA) is a state of autonomous aldosterone secretion which is unresponsive to renin regulation, resulting in hypertension and electrolyte imbalance [1]
The studies were examined independently by the same authors as full-text reports according to the following criteria: (i) inclusion of patients with aldosterone-producing adenoma, idiopathic hyperaldosteronism, and essential hypertension; (ii) studies with both adrenalectomy and mineralocorticoid receptor antagonist (MRA) treatment of patients with PA; (iii) new-onset atrial fibrillation (NOAF) included as an outcome treatment variable; (iv) exclusion of patients with a history of atrial fibrillation; and (v) limited to human studies
Primary Outcome: Risk of NOAF in the PA Patients Receiving MRA Treatment Compared to the PA Patients Receiving Adrenalectomy MRA treatment was significantly associated with a higher incidence of NOAF compared to adrenalectomy in both the fixed effects model (OR: 2.83, 95% confidence intervals (CIs): 1.76–4.57) (Figure 2A) and random effects model (OR: 2.83, 95% CI: 1.76–4.57) (Figure 2B)

Summary

Introduction

Primary aldosteronism (PA) is a state of autonomous aldosterone secretion which is unresponsive to renin regulation, resulting in hypertension and electrolyte imbalance [1]. PA is associated with higher risks of cardiovascular, renal, and metabolic complications [4,5,6,7,8]. Primary aldosteronism (PA) is a common cause of secondary hypertension and associated with higher incidence of new-onset atrial fibrillation (NOAF). The effects of surgical or medical therapies on preventing NOAF in PA patents remain unclear. The aim of this meta-analysis study was to assess the risk of NOAF among PA patients receiving mineralocorticoid receptor antagonist (MRA) treatment, PA patients receiving adrenalectomy, and patients with essential hypertension

Methods

Results

Conclusion