CONTEXT Primary aldosteronism (PA) is one of the most common causes of secondary hypertension, but the comparative outcomes of targeted treatment remain unclear. OBJECTIVES To compare the clinical outcomes in patients treated for primary aldosteronism over time. DATA SOURCES Medline and EMBASE. STUDY SELECTION Original studies reporting incidence of mortality, major adverse cardiovascular outcomes (MACE), progression to chronic kidney disease, or diabetes following adrenalectomy versus medical therapy. DATA EXTRACTION 2 reviewers independently abstracted data and assessed study quality. Standard meta-analyses were conducted using random effects models to estimate relative differences. Time-to-benefit meta-analyses were conducted by fitting Weibull survival curves to estimate absolute risk differences and pooled using random-effects models. DATA SYNTHESIS 15,541 patients (16 studies) with PA were included. Surgery was consistently associated with an overall lower risk of death (HR, 0.34 [95% CI, 0.22 to 0.54]) and MACE (HR, 0.55 [95% CI, 0.36 to 0.84]), compared to medical therapy. Surgery was associated with a significantly lower risk of hospitalization for heart failure (HR, 0.48 [95% CI, 0.34 to 0.70]) and progression to chronic kidney disease (HR, 0.62 [95% CI, 0.39 to 0.98]), and non-significant reductions in myocardial infarction and stroke. In absolute terms, 200 patients would need to be treated with surgery instead of medical therapy to prevent 1 death after 12.3 (95% CI, 3.1 to 48.7) months. CONCLUSION Surgery is associated with lower all-cause mortality and MACE compared to medical therapy for primary aldosteronism. For most patients, the long-term surgical benefits outweigh the short-term perioperative risks.

中文翻译：

---

原发性醛固酮增多症患者的手术与靶向药物治疗的获益时间：荟萃分析。

背景 原发性醛固酮增多症 (PA) 是继发性高血压的最常见原因之一，但靶向治疗的比较结果仍不清楚。目的 比较原发性醛固酮增多症患者随时间推移的临床结果。数据来源 Medline 和 EMBASE。研究选择 原始研究报告了肾上腺切除术后与药物治疗相比死亡率、主要不良心血管结局 (MACE)、慢性肾病进展或糖尿病的发生率。数据提取 2 名评审员独立提取数据并评估研究质量。使用随机效应模型进行标准荟萃分析来估计相对差异。通过拟合威布尔生存曲线来估计绝对风险差异并使用随机效应模型进行汇总，进行受益时间荟萃分析。数据综合 15,541 名 PA 患者（16 项研究）纳入其中。与药物治疗相比，手术始终与较低的总体死亡风险（HR，0.34 [95% CI，0.22 至 0.54]）和 MACE（HR，0.55 [95% CI，0.36 至 0.84]）相关。手术与显着降低因心力衰竭住院的风险（HR，0.48 [95% CI，0.34 至 0.70]）和进展为慢性肾病（HR，0.62 [95% CI，0.39 至 0.98]）的风险相关。 -显着减少心肌梗塞和中风。从绝对值来看，12.3（95% CI，3.1 至 48.7）个月后，200 名患者需要接受手术而不是药物治疗，以防止 1 人死亡。结论 与原发性醛固酮增多症的药物治疗相比，手术可降低全因死亡率和 MACE。对于大多数患者来说，长期手术获益超过短期围手术期风险。