Figure 6.

Incident composite cardiovascular events in medically and surgically treated primary aldosteronism when compared with essential hypertension. When compared with age-matched and blood pressure–similar patients with essential hypertension, patients with primary aldosteronism treated with MR antagonists had a nearly threefold higher risk for incident cardiovascular events (myocardial infarction, stroke, heart failure hospitalization) when renin remained suppressed (82). In contrast, patients with primary aldosteronism treated with MR antagonists such that their renin increased, as well as patients with unilateral primary aldosteronism treated with surgical adrenalectomy, had no significant difference in the risk for incident cardiovascular events when compared with essential hypertension (82). Similar findings were observed with respect to the risk for atrial fibrillation (236) and death (82). Dashed lines represent unadjusted cumulative incidence curves; solid lines represent adjusted cumulative incidence curves. PRA, plasma renin activity. Adapted with permission from Hundemer GL, Curhan GC, Yozamp N, et al. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol 2018;6(1):51–59. [© 2018 Illustration Presentation ENDOCRINE SOCIETY]