Table 1.

Summary of selected recent studies (2016–2020) comparing medical and surgical treatment of PA.

Study	Year	Study Design	Primary Outcome	Study Groups	Results
Wu et al, Sci. Rep. [69]	2016	Retrospective cohort	All-cause mortality	PA +ADX (n=822), matched 1:1 on comorbidities with PA +MRA (n=822)	ADX demonstrated survival benefit (HR: 0.23, p<0.001 with residual hypertension; HR: 0.21, p<0.001 without residual hypertension)
Hundemer et al, Hypertension [67]	2018	Retrospective cohort	Renal function	PA +ADX (n=120), PA +MRA (n=400), age and GFR-matched PH (n=15474)	ADX was not associated with worse renal outcomes compared to EH; MRA treatment in PA associated with annual decline in GFR (−1.2 ml/min/1.73 m2/y, p<0.001) and higher risk of CKD (HR 1.63) compared to PH
Rossi et al, Hypertension [64]	2018	Longitudinal observation cohort	Atrial fibrillation	PA with lateralizing AVS +ADX (n=41), PA with idiopathic hyperaldosteronism +MRA (n=66)	ADX associated with lower risk of atrial fibrillation compared to MRA (HR: 1.82, p=0.025)
Hundemer et al, JAMA Cardiol. [62]	2018	Retrospective cohort	Atrial fibrillation	PA +ADX (n=201), PA +MRA (n=195), age-matched PH (n=40,092)	PA +MRA with suppressed renin (<1 ng/ml/hr) had higher risk of atrial fibrillation (HR: 2.55, 95% CI: 1.75–3.71) compared to PA +ADX, PA +MRA with non-suppressed renin, and PH
Velema et al, JCEM [73]	2018	Post hoc comparative effectiveness study within randomized clinical trial (SPARTACUS)	Quality of life (QoL)	PA +ADX (n=92), PA +MRA (n=92)	Both ADX and MRA treatment improved QoL after 1 year. ADX associated with better QoL compared to MRA despite equivalent blood pressure control
Katabami et al, J Hypertension [68]	2019	Retrospective cohort	Renal function, blood pressure, anti-hypertensive medication use	PA with APA +ADX (n=276), PA with APA +MRA (n=63)	After 6 months, ADX associated with lower number of antihypertensive medications, higher rates of normal blood pressure, and improved GFR compared with patients on MRA (−12.6 versus −9.0 ml/min per 1.73 m2, p=0.003).
Chang et al, Surgery [76]	2020	Retrospective cohort	Stroke	PA with APA +ADX (n=1047), PA +MRA (n=3167), each subgroup matched 1:4 with PH	ADX associated with lower risk of stroke compared to subjects with PH (HR: 0.53, p<0.001); MRA was not (HR: 1.66, p<0.001)
Pan et al, J Amer. Heart Assoc. [61]	2020	Retrospective cohort	New onset atrial fibrillation	PA +ADX (n=1101), PA +MRA (n=1101), matched with PH (N=8808)	ADX associated with lower risk of atrial fibrillation compared to subjects with PH (HR: 0.29, p=0.014); MRA was not (HR: 1.19, p=0.240)

ADX – Adrenalectomy; APA – Aldosterone producing adenoma; CKD – Chronic kidney disease; GFR – Glomerular filtration rate; HR – Hazard Ratio; MRA – Mineralocorticoid antagonist; PA – Primary aldosteronism; PH – Primary hypertension; QoL – Quality of life