The following is a summary of “Implication of MR Activity in Posttreatment Arterial Stiffness Reversal in Patients With Primary Aldosteronism,” published in the March 2023 issue of Endocrinology & Metabolism by Chen, et al.

For a study, researchers sought to compare the reversal of arterial stiffness between surgically and medically treated primary aldosteronism (PA) patients and to identify the predictors of adequate medical treatment. 

Before treatment and one year later, they prospectively enrolled 445 PA patients and collected information on their baseline clinical traits, biochemistry, blood pressure, and pulse wave velocity (PWV). In addition, the connection between the change in PWV after 1 year (Δ PWV) and posttreatment renin activity was investigated in the mineralocorticoid receptor antagonist (MRA)-treated patients using the restricted cubic spline (RCS) approach. 

In the study, 445 patients with PA were enrolled and divided into two groups based on their treatment method. Of the patients, 255 received adrenalectomy, and 190 were given mineralocorticoid receptor antagonists (MRAs). Investigators found that a plasma renin activity (PRA) level of 1.5 ng/mL/h was the best cutoff value when using the restricted cubic spline (RCS) method. Based on this, the MRA-treated patients were divided into two groups: group 2 with suppressed PRA (<1.5 ng/mL/h) and Group 3 with unsuppressed PRA (≥1.5 ng/mL/h). After treatment, there was a significant improvement in pulse wave velocity (PWV) in group 1 and group 3 (both P<.001), but no significant improvement in group 2 (P = .151). In the post hoc analysis, group 2 had a significantly lower ΔPWV than Group 1 (P = .007) and Group 3 (P = .031). The multivariable regression analysis identified posttreatment PRA, age, and baseline PWV as independent factors correlated with ΔPWV in MRA-treated PA patients.

In PA patients undergoing adrenalectomy and in PA patients getting medicinal treatment who had unsuppressed PRA, vascular stiffness was reversed.

Source: academic.oup.com/jcem/article/108/3/624/6802624