Surgery decreases the long-term incident stroke risk in patients with primary aldosteronism
Hypertension with hyperaldosteronism could be associated with stroke attributable to endothelial injury. Whether the detrimental effect of aldosterone on stroke among primary aldosteronism patients could be mitigated by administration of mineralocorticoid receptor antagonist or by reduction of aldos...
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| Veröffentlicht in: | Surgery 2020-02, Vol.167 (2), p.367-377 |
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| creator | Chang, Yu-hsing Chung, Shiu-Dong Wu, Che-Hsiung Chueh, Jeff S. Chen, Likwang Lin, Po-Chih Lin, Yen-Hung Huang, Kuo-How Wu, Vin-Cent Chu, Tzong-Shinn |
| description | Hypertension with hyperaldosteronism could be associated with stroke attributable to endothelial injury. Whether the detrimental effect of aldosterone on stroke among primary aldosteronism patients could be mitigated by administration of mineralocorticoid receptor antagonist or by reduction of aldosterone level via adrenalectomy is still inconclusive.
Primary aldosteronism and essential hypertensive patients were enrolled in the Taiwan National Health Insurance from 1997 to 2009. We used a validated algorithm to enroll primary aldosteronism patients. We conducted a competing risk analysis, using a time-varying Cox proportional hazard model.
We enrolled 3,167 primary aldosteronism patients with a subgroup of 1,047 aldosterone-producing adenoma patients, and matched these with essential hypertensive controls in a 1:4 ratio. The risk of incident stroke, both ischemic and hemorrhagic, was statistically higher in primary aldosteronism patients than in their essential hypertensive control. The differences in stroke incidences between primary aldosteronism and essential hypertensive patients significantly increased as the hypertensive period lengthened. Primary aldosteronism patients who received mineralocorticoid receptor antagonist treatment had higher risk of all stroke (competing hazard ratio = 1.83, P < .001) compared with their essential hypertensive controls. In light of this, aldosterone-producing adenoma patients had a lower risk of incident stroke after adrenalectomy (competing for hazard ratio = 0.75), but a higher cumulative risk of incident stroke after mineralocorticoid receptor antagonist only (competing for hazard ratio = 1.76) than their matched essential hypertensive patients.
We observed an increased stroke risk among primary aldosteronism patients than among their matched essential hypertensive controls. A prolonged duration of hypertension was proportionate to the raised risk of stroke. Our findings emphasize the importance of aldosterone-producing adenoma benefitting from adrenalectomy in attenuating the cerebrovascular event. |
| doi_str_mv | 10.1016/j.surg.2019.08.017 |
| format | Article |
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Primary aldosteronism and essential hypertensive patients were enrolled in the Taiwan National Health Insurance from 1997 to 2009. We used a validated algorithm to enroll primary aldosteronism patients. We conducted a competing risk analysis, using a time-varying Cox proportional hazard model.
We enrolled 3,167 primary aldosteronism patients with a subgroup of 1,047 aldosterone-producing adenoma patients, and matched these with essential hypertensive controls in a 1:4 ratio. The risk of incident stroke, both ischemic and hemorrhagic, was statistically higher in primary aldosteronism patients than in their essential hypertensive control. The differences in stroke incidences between primary aldosteronism and essential hypertensive patients significantly increased as the hypertensive period lengthened. Primary aldosteronism patients who received mineralocorticoid receptor antagonist treatment had higher risk of all stroke (competing hazard ratio = 1.83, P < .001) compared with their essential hypertensive controls. In light of this, aldosterone-producing adenoma patients had a lower risk of incident stroke after adrenalectomy (competing for hazard ratio = 0.75), but a higher cumulative risk of incident stroke after mineralocorticoid receptor antagonist only (competing for hazard ratio = 1.76) than their matched essential hypertensive patients.
We observed an increased stroke risk among primary aldosteronism patients than among their matched essential hypertensive controls. A prolonged duration of hypertension was proportionate to the raised risk of stroke. Our findings emphasize the importance of aldosterone-producing adenoma benefitting from adrenalectomy in attenuating the cerebrovascular event.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2019.08.017</identifier><identifier>PMID: 31676114</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adrenalectomy ; Adrenocortical Adenoma - complications ; Adrenocortical Adenoma - surgery ; Adult ; Aged ; Cohort Studies ; Female ; Humans ; Hyperaldosteronism - complications ; Hyperaldosteronism - drug therapy ; Hyperaldosteronism - mortality ; Hyperaldosteronism - surgery ; Incidence ; Male ; Middle Aged ; Mineralocorticoid Receptor Antagonists - therapeutic use ; Stroke - epidemiology ; Stroke - etiology ; Taiwan - epidemiology</subject><ispartof>Surgery, 2020-02, Vol.167 (2), p.367-377</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-d4aac8913721bfd1cbf0a5e883790c949ba4abb2f236340ee09c92d3828bbc253</citedby><cites>FETCH-LOGICAL-c356t-d4aac8913721bfd1cbf0a5e883790c949ba4abb2f236340ee09c92d3828bbc253</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.surg.2019.08.017$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31676114$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chang, Yu-hsing</creatorcontrib><creatorcontrib>Chung, Shiu-Dong</creatorcontrib><creatorcontrib>Wu, Che-Hsiung</creatorcontrib><creatorcontrib>Chueh, Jeff S.</creatorcontrib><creatorcontrib>Chen, Likwang</creatorcontrib><creatorcontrib>Lin, Po-Chih</creatorcontrib><creatorcontrib>Lin, Yen-Hung</creatorcontrib><creatorcontrib>Huang, Kuo-How</creatorcontrib><creatorcontrib>Wu, Vin-Cent</creatorcontrib><creatorcontrib>Chu, Tzong-Shinn</creatorcontrib><creatorcontrib>TAIPAI Study Group</creatorcontrib><title>Surgery decreases the long-term incident stroke risk in patients with primary aldosteronism</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Hypertension with hyperaldosteronism could be associated with stroke attributable to endothelial injury. Whether the detrimental effect of aldosterone on stroke among primary aldosteronism patients could be mitigated by administration of mineralocorticoid receptor antagonist or by reduction of aldosterone level via adrenalectomy is still inconclusive.
Primary aldosteronism and essential hypertensive patients were enrolled in the Taiwan National Health Insurance from 1997 to 2009. We used a validated algorithm to enroll primary aldosteronism patients. We conducted a competing risk analysis, using a time-varying Cox proportional hazard model.
We enrolled 3,167 primary aldosteronism patients with a subgroup of 1,047 aldosterone-producing adenoma patients, and matched these with essential hypertensive controls in a 1:4 ratio. The risk of incident stroke, both ischemic and hemorrhagic, was statistically higher in primary aldosteronism patients than in their essential hypertensive control. The differences in stroke incidences between primary aldosteronism and essential hypertensive patients significantly increased as the hypertensive period lengthened. Primary aldosteronism patients who received mineralocorticoid receptor antagonist treatment had higher risk of all stroke (competing hazard ratio = 1.83, P < .001) compared with their essential hypertensive controls. In light of this, aldosterone-producing adenoma patients had a lower risk of incident stroke after adrenalectomy (competing for hazard ratio = 0.75), but a higher cumulative risk of incident stroke after mineralocorticoid receptor antagonist only (competing for hazard ratio = 1.76) than their matched essential hypertensive patients.
We observed an increased stroke risk among primary aldosteronism patients than among their matched essential hypertensive controls. A prolonged duration of hypertension was proportionate to the raised risk of stroke. Our findings emphasize the importance of aldosterone-producing adenoma benefitting from adrenalectomy in attenuating the cerebrovascular event.</description><subject>Adrenalectomy</subject><subject>Adrenocortical Adenoma - complications</subject><subject>Adrenocortical Adenoma - surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Hyperaldosteronism - complications</subject><subject>Hyperaldosteronism - drug therapy</subject><subject>Hyperaldosteronism - mortality</subject><subject>Hyperaldosteronism - surgery</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mineralocorticoid Receptor Antagonists - therapeutic use</subject><subject>Stroke - epidemiology</subject><subject>Stroke - etiology</subject><subject>Taiwan - epidemiology</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD1vFDEQhi1ERC6BP0CBXNLsMmPvetcSDYoCRIpEkVBRWF57NvFlPw7bR8S_x6c7KKlGGr3vo5mHsbcINQKqD9s67eNDLQB1DX0N2L1gG2ylqDqp8CXbAEhdKVBwzi5S2gKAbrB_xc4lqk4hNhv2464gKP7mnlwkmyjx_Eh8WpeHKlOceVhc8LRknnJcn4jHkJ7Kku9sDmWd-HPIj3wXw2wLxU5-TaW3LiHNr9nZaKdEb07zkn3_fH1_9bW6_fbl5urTbeVkq3LlG2tdr1F2AofRoxtGsC31vew0ON3owTZ2GMQopJINEIF2WnjZi34YnGjlJXt_5O7i-nNPKZs5JEfTZBda98kIiajatoVDVByjLq4pRRrN6XKDYA5SzdYcpJqDVAO9KVJL6d2Jvx9m8v8qfy2WwMdjgMqXvwJFk1yR48iHSC4bv4b_8f8A99mKUA</recordid><startdate>202002</startdate><enddate>202002</enddate><creator>Chang, Yu-hsing</creator><creator>Chung, Shiu-Dong</creator><creator>Wu, Che-Hsiung</creator><creator>Chueh, Jeff S.</creator><creator>Chen, Likwang</creator><creator>Lin, Po-Chih</creator><creator>Lin, Yen-Hung</creator><creator>Huang, Kuo-How</creator><creator>Wu, Vin-Cent</creator><creator>Chu, Tzong-Shinn</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202002</creationdate><title>Surgery decreases the long-term incident stroke risk in patients with primary aldosteronism</title><author>Chang, Yu-hsing ; Chung, Shiu-Dong ; Wu, Che-Hsiung ; Chueh, Jeff S. ; Chen, Likwang ; Lin, Po-Chih ; Lin, Yen-Hung ; Huang, Kuo-How ; Wu, Vin-Cent ; Chu, Tzong-Shinn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-d4aac8913721bfd1cbf0a5e883790c949ba4abb2f236340ee09c92d3828bbc253</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adrenalectomy</topic><topic>Adrenocortical Adenoma - complications</topic><topic>Adrenocortical Adenoma - surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Hyperaldosteronism - complications</topic><topic>Hyperaldosteronism - drug therapy</topic><topic>Hyperaldosteronism - mortality</topic><topic>Hyperaldosteronism - surgery</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mineralocorticoid Receptor Antagonists - therapeutic use</topic><topic>Stroke - epidemiology</topic><topic>Stroke - etiology</topic><topic>Taiwan - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chang, Yu-hsing</creatorcontrib><creatorcontrib>Chung, Shiu-Dong</creatorcontrib><creatorcontrib>Wu, Che-Hsiung</creatorcontrib><creatorcontrib>Chueh, Jeff S.</creatorcontrib><creatorcontrib>Chen, Likwang</creatorcontrib><creatorcontrib>Lin, Po-Chih</creatorcontrib><creatorcontrib>Lin, Yen-Hung</creatorcontrib><creatorcontrib>Huang, Kuo-How</creatorcontrib><creatorcontrib>Wu, Vin-Cent</creatorcontrib><creatorcontrib>Chu, Tzong-Shinn</creatorcontrib><creatorcontrib>TAIPAI Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chang, Yu-hsing</au><au>Chung, Shiu-Dong</au><au>Wu, Che-Hsiung</au><au>Chueh, Jeff S.</au><au>Chen, Likwang</au><au>Lin, Po-Chih</au><au>Lin, Yen-Hung</au><au>Huang, Kuo-How</au><au>Wu, Vin-Cent</au><au>Chu, Tzong-Shinn</au><aucorp>TAIPAI Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgery decreases the long-term incident stroke risk in patients with primary aldosteronism</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2020-02</date><risdate>2020</risdate><volume>167</volume><issue>2</issue><spage>367</spage><epage>377</epage><pages>367-377</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Hypertension with hyperaldosteronism could be associated with stroke attributable to endothelial injury. Whether the detrimental effect of aldosterone on stroke among primary aldosteronism patients could be mitigated by administration of mineralocorticoid receptor antagonist or by reduction of aldosterone level via adrenalectomy is still inconclusive.
Primary aldosteronism and essential hypertensive patients were enrolled in the Taiwan National Health Insurance from 1997 to 2009. We used a validated algorithm to enroll primary aldosteronism patients. We conducted a competing risk analysis, using a time-varying Cox proportional hazard model.
We enrolled 3,167 primary aldosteronism patients with a subgroup of 1,047 aldosterone-producing adenoma patients, and matched these with essential hypertensive controls in a 1:4 ratio. The risk of incident stroke, both ischemic and hemorrhagic, was statistically higher in primary aldosteronism patients than in their essential hypertensive control. The differences in stroke incidences between primary aldosteronism and essential hypertensive patients significantly increased as the hypertensive period lengthened. Primary aldosteronism patients who received mineralocorticoid receptor antagonist treatment had higher risk of all stroke (competing hazard ratio = 1.83, P < .001) compared with their essential hypertensive controls. In light of this, aldosterone-producing adenoma patients had a lower risk of incident stroke after adrenalectomy (competing for hazard ratio = 0.75), but a higher cumulative risk of incident stroke after mineralocorticoid receptor antagonist only (competing for hazard ratio = 1.76) than their matched essential hypertensive patients.
We observed an increased stroke risk among primary aldosteronism patients than among their matched essential hypertensive controls. A prolonged duration of hypertension was proportionate to the raised risk of stroke. Our findings emphasize the importance of aldosterone-producing adenoma benefitting from adrenalectomy in attenuating the cerebrovascular event.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31676114</pmid><doi>10.1016/j.surg.2019.08.017</doi><tpages>11</tpages></addata></record> |
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| ispartof | Surgery, 2020-02, Vol.167 (2), p.367-377 |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adrenalectomy Adrenocortical Adenoma - complications Adrenocortical Adenoma - surgery Adult Aged Cohort Studies Female Humans Hyperaldosteronism - complications Hyperaldosteronism - drug therapy Hyperaldosteronism - mortality Hyperaldosteronism - surgery Incidence Male Middle Aged Mineralocorticoid Receptor Antagonists - therapeutic use Stroke - epidemiology Stroke - etiology Taiwan - epidemiology |
| title | Surgery decreases the long-term incident stroke risk in patients with primary aldosteronism |
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