REVIEW article
Front. Endocrinol.
Sec. Adrenal Endocrinology
This article is part of the Research TopicRecent Advances in the Molecular and Genetic Landscape of Primary AldosteronismView all articles
Primary Aldosteronism: Pharmacotherapy vs Surgery vs Embolization Efficacy – Systematic Review and Network Meta-Analysis of Studies Predominantly Conducted in China
Provisionally accepted
- 1Mianzhu People's Hospital, Mianzhu, China
- 2Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 3Cangxi County People's Hospital, Guangyuan, China
- 4Zitong County People's Hospital, Mianyang, China
- 5School of Clinical Medical ,Chengdu medical college, Chengdu, China
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Background: Primary aldosteronism (PA) is one of major cause of resistant hypertension. This study compares the efficacy and safety of current treatments, including pharmacotherapy, adrenalectomy, and minimally invasive techniques, to guide clinical practice. Method:We systematically searched Embase, PubMed, Cochrane, Web of Science, CNKI, Wanfang, and VIP from inception to August 13, 2024, for randomized controlled trials and cohort studies involving adult patients with PA and hypertension. Reporting quality of the included studies was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the Newcastle-Ottawa Scale (NOS) for cohort studies. Data analysis was performed using R 4.3.3 and STATA 15.0. Results: This study included 17 articles involving 1,496 patients, of which 13 studies (76%) were conducted in China. Meta-analysis showed that for systolic blood pressure (SBP), unilateral total adrenalectomy and renal nerve denervation (TADR+RND) was most effective (WMD = -12.53, 95% Crl -15.18 to -9.90). For diastolic blood pressure (DBP), Partial adrenalectomy (PADR) (WMD = -9.31, 95% Crl -12.97 to -5.68). PADR also maintained serum potassium levels effectively (0.64, 95% Crl 0.52 to 0.75). Among pharmacological treatments, mineralocorticoid receptor antagonists and irbesartan (MRAs+IRB) had the greatest antihypertensive effect (SBP: WMD = -18.90, 95% Crl -29.20 to -8.55; DBP: WMD = -22.14, 95% Crl -31.81 to -12.50). Mineralocorticoid receptor antagonists did not significantly reduce plasma aldosterone concentration (PAC), consistent with their known feedback-related tendency to increase PAC. Conclusions: This study showed TADR + RND and MRAs + IRB had best efficacy in surgical and pharmacological treatments, respectively, but 76% of the included studies were conducted in China, which may affect the generalizability of the findings. Therefore, the results need further validation.
Keywords: primary aldosteronism, Adrenalectomy, Radiofrequency ablation, Superselective Adrenal Artery Embolization, Meta-analysis
Received: 11 Jun 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Li, Li, Xu, Li, Hu and Qin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gang Li, 2238617767@qq.com
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