Publications

Authors:

Marzano, Luigi; Zoccatelli, Francesca; Pizzolo, Francesca; Friso, Simonetta

Title:

Adrenalectomy Versus Medical Therapy in Primary Aldosteronism: A Meta-Analysis of Long-Term Cardiac Remodeling and Function: Medical Versus Adrenalectomy Treatment Compared in Hyperaldosteronism (MATCH) Study

Year:

2025

Type of item:

Articolo in Rivista

Tipologia ANVUR:

Articolo su rivista

Language:

Inglese

Referee:

No

Name of journal:

Hypertension

ISSN of journal:

0194-911X

Page numbers:

1-9

Keyword:

adrenalectomy; primary aldosteronism; hypertension; arterial hypertension; Cardiac Remodeling

Short description of contents:

Background: Primary aldosteronism (PA) is a common curable cause of secondary hypertension that significantly increases left ventricular mass (LVM) and predisposes patients to adverse cardiovascular outcomes. Although adrenalectomy and medical therapy with mineralocorticoid receptor antagonists (MRAs) are both used to treat PA, their long-term comparative efficacy in reversing cardiac structural changes remains debated. Methods: We systematically searched MEDLINE and Embase for prospective and retrospective clinical trials published up to November 22, 2024, with a minimum follow-up of 6 months that reported changes in LVM in patients with PA treated with adrenalectomy or MRAs. Data were independently extracted by 2 reviewers, and risk-of-bias assessments were conducted using standardized tools. The primary outcome was the percentage reduction in indexed LVM; secondary outcomes included changes in cardiac remodeling, and systolic and diastolic function parameters. Results: Seventeen studies comprising 1696 patients (49% adrenalectomy, 51% MRA therapy) were analyzed. Adrenalectomy yielded a significantly greater indexed LVM reduction (mean difference, -3.5% [95% CI, -4.9% to -2.2%]; P<0.0001) and a 32% reduction in left ventricular hypertrophy risk ratio, compared with a 19% reduction with MRAs. Meta-regression revealed that shorter hypertension duration predicted greater LVM regression following adrenalectomy, whereas high dietary sodium attenuated MRA effects. In addition, left ventricular ejection fraction improved modestly after adrenalectomy. Conclusions: Adrenalectomy provides superior long-term regression of LVM and left ventricular hypertrophy compared with MRAs in PA, supporting its use as the first-line treatment for unilateral PA. Future research should compare emerging nonsteroidal MRAs and aldosterone synthase inhibitors to further optimize cardiac remodeling outcomes.

Web page:

https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.125.25104

Product ID:

146526

Handle IRIS:

11562/1165774

Last Modified:

June 28, 2025

Bibliographic citation:

Marzano, Luigi; Zoccatelli, Francesca; Pizzolo, Francesca; Friso, Simonetta, Adrenalectomy Versus Medical Therapy in Primary Aldosteronism: A Meta-Analysis of Long-Term Cardiac Remodeling and Function: Medical Versus Adrenalectomy Treatment Compared in Hyperaldosteronism (MATCH) Study «Hypertension» , 2025 , pp. 1-9

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