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

AIM: This study aimed to evaluate whether the increased cardiovascular risk and the incidence of cerebrovascular (CCV) events in hypertensive patients were related to primary aldosteronism (PA). METHODS: The PubMed, EmBase, and the Cochrane Central Register of Controlled Trials were searched to evaluate the risk of CCV in PA patients and compared to essential hypertension (EH) patients. The mean differences (MD) and the risk ratios (RR) were calculated to assess the risk of main outcomes, such as stroke, coronary artery disease, left ventricular hypertrophy (LVH), levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose, and urinary potassium. RESULTS: We identified 31 individual studies including 4546 patients in PA group and 52,284 patients in EH group. Our results revealed that PA was significantly associated with increased risk of stroke (RR=2.03, 95% CI = 1.71–2.39, P(heterogeneity) = .331, I(2) = 12.7%), coronary artery disease (RR = 1.67, 95% CI = 1.23–2.25, P(heterogeneity) = .043, I(2) = 48.3%), and LVH (RR = 1.54, 95% CI = 1.29–1.83, P(heterogeneity) = .004, I(2) = 62.6%) when compared with those in the EH group. Moreover, PA group had significantly increased levels of SBP (WMD = 4.14, 95% CI = 2.60–5.68, P(heterogeneity) < .001, I(2) = 84.3%), DBP (WMD = 2.65, 95% CI = 1.83–3.47, P(heterogeneity) < .001, I(2) = 77.7%), and urinary potassium (SMD = 0.04, 95% CI = -0.03–0.11, P(heterogeneity) = .827, I(2) = 0%) when compared to EH group. However, no significant difference was observed in the levels of blood glucose between the groups. CONCLUSIONS: These findings suggested that PA significantly increased the risk of cardiac and cerebrovascular complications. In addition, patients with PA might benefit from a periodic assessment of CCV risk.