A Comparison of Adrenalectomy and Eplerenone on Vascular Function in Patients with Aldosterone-producing Adenoma.

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It remains unclear whether adrenalectomy has more beneficial effects than treatment with a mineralocorticoid receptor antagonist on vascular function in patients with aldosterone-producing adenoma (APA).The aim of this study was to compare the effects of adrenalectomy and treatment with eplerenone on vascular function in patients with APA.Flow-mediated vasodilation (FMD) as an index of endothelium-dependent vasodilation and nitroglycerine-induced vasodilation (NID) as an index of endothelium-independent vasodilation were measured to assess vascular function before and after 3-month treatment with eplerenone and at 3 months after adrenalectomy in 23 patients with APA.FMD and NID after adrenalectomy were significantly higher than those before treatment with eplerenone (5.4±2.6% vs. 2.7±1.9% and 14.8±4.7% vs. 9.6±4.6%, P<0.01, respectively) and those after treatment with eplerenone (5.4±2.6% vs. 3.1±2.3% and 14.8±4.7% vs. 11.0±5.3%, P<0.01 and P=0.03, respectively), while treatment with eplerenone did not alter FMD and NID compared with those before treatment with eplerenone. After adrenalectomy, the increase in FMD and NID were significantly correlated with the decrease in PAC and the decrease in aldosterone-renin ratio. There were no significant relationships between FMD and changes in other parameters or between NID and changes in other parameters.Adrenalectomy, but not treatment with eplerenone, improved vascular function in patients with APA. Adrenalectomy may be more effective than treatment with eplerenone for reducing the incidence of future cardiovascular events in patients with APA.

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