Research in context
Evidence before this study
Primary aldosteronism is the most frequent form of endocrine hypertension. Experimental studies in different animal models have linked aldosterone excess with vascular and perivascular inflammation, oxidative stress, and fibrosis. Aldosterone promotes insulin resistance and its levels have been found to be inversely correlated with C-peptide and β-cell mass. Existing reported studies have often, but not always, linked autonomous aldosterone overproduction with an increased risk of cardiovascular and cerebrovascular events and cardiac target organ damage in patients affected by primary aldosteronism. Relevant articles with full text in English were evaluated in MEDLINE, and Cochrane Library in keeping with established methods with terms associated with primary aldosteronism (eg, “primary aldosteronism”, “hyperaldosteronism”, and “primary aldosteronism/hyperaldosteronism”, and the following terms: “left ventricular hypertrophy”, “myocardial infarction”, “atrial fibrillation”, “heart failure”, “percutaneous transluminal coronary angioplasty”, “stroke”, “metabolic syndrome”, and “diabetes”) up to Feb 28, 2017, with no start date restriction.
Added value of this study
Results from this comprehensive meta-analysis including 31 studies for 3838 patients with primary aldosteronism and 9284 patients with essential hypertension indicate that primary aldosteronism is associated with an increased rate of cardiovascular and cerebrovascular morbidity, including stroke, coronary artery disease, heart failure, and atrial fibrillation relative to patients with essential hypertension. Patients with primary aldosteronism also display an increased prevalence of metabolic alterations such as metabolic syndrome and diabetes.
Implications of all the available evidence
Findings from our systematic review and meta-analysis further support the importance of the early and systematic screening for primary aldosteronism in most, if not all, hypertensive patients to allow the initiation of specific treatment for primary aldosteronism that might reverse the excess cardiovascular risk.