Table 1. Comparison of patient characteristics between patients with ADX and MRA
|
Older (Age ≥65 y)
|
Younger (Age <65 y)
|
|
ADX
N = 96
|
MRA
N = 57
|
P-Value
|
ADX
N = 526
|
MRA
N = 176
|
P-Value
|
Baseline characteristics
|
|
|
|
|
|
|
Age, years
|
67 (65-70)
|
68 (66-72)
|
0.18
|
50 (40-57)
|
53 (46-60)
|
<0.01
|
Female, n (%)
|
37 (39)
|
31 (54)
|
0.07
|
263 (50)
|
67 (38)
|
<0.01
|
BMI, kg/m2
|
23.7 ± 3.69
|
23.6 ± 3.27
|
0.99
|
24.2 ± 4.11
|
25.4 ± 4.16
|
<0.01
|
SBP, mmHg
|
143.3 ± 18.3
|
142.1 ± 15.8
|
0.69
|
141.3 ± 18.9
|
142.6 ± 17.5
|
0.42
|
DBP, mmHg
|
81.1 ± 12.5
|
81.0 ± 11.9
|
0.95
|
87.7 ± 12.1
|
88.3 ± 12.7
|
0.62
|
eGFR, mL/min/1.73m2
|
67.4 ± 17.4
|
66.6 ± 17.4
|
0.80
|
81.6 ± 22.9
|
76.4 ± 17.3
|
<0.01
|
Duration of HT, years
|
19 (10-26)
|
15 (6-23)
|
0.052
|
7 (2-12)
|
7 (3-15)
|
0.51
|
Hypokalemia, n (%)
|
77 (80)
|
28 (49)
|
<0.01
|
409 (78)
|
91 (52)
|
<0.01
|
Proteinuria, n (%)
|
22 (24)
(n = 91)
|
17 (31)
(n = 55)
|
0.37
|
90 (18)
(n = 497)
|
25 (15)
(n = 167)
|
0.41
|
PA characteristics
|
|
|
|
|
|
|
Lateralization index
|
12.7 (7.5-27.3)
|
6.9 (4.2-12.8)
|
<0.01
|
12.1 (6.1-26.8)
|
6.2 (3.4-13.4)
|
<0.01
|
PRA, ng/mL/h
|
|
|
|
|
|
|
Baseline
|
0.2 (0.1-0.4)
|
0.2 (0.1-0.4)
|
0.53
|
0.3 (0.2-0.4)
|
0.3 (0.2-0.5)
|
0.01
|
6 or 12M
|
0.7 (0.4-1.4)
(n = 70)
|
0.4 (0.3-1.3)
(n = 25)
|
<0.01
|
1.1 (0.5-2.2)
(n = 409)
|
0.8 (0.4-1.6)
(n = 122)
|
<0.01
|
PAC, pg/mL
|
|
|
|
|
|
|
Baseline
|
281 (181-396)
|
186 (139-286)
|
<0.01
|
316 (211-469)
|
195 (147-314)
|
<0.01
|
6 or 12 M
|
80 (57-123)
(n = 74)
|
299 (170-465)
(n = 28)
|
<0.01
|
99 (72-136)
(n = 421)
|
268 (183-391)
(n = 128)
|
<0.01
|
Values are mean ± standard deviation, median (interquartile range), or n (%). ADX, adrenalectomy; ARR, aldosterone-renin ratio; BMI, body mass index; DBP, diastolic blood pressure; DDD, defined daily dose; eGFR, estimated glomerular filtration rate; HT, hypertension; MRA, mineralocorticoid receptor antagonist; PAC, plasma aldosterone concentration; PRA, plasma renin activity; SBP, systolic blood pressure.
Table 2. Comparison of post-operative outcomes between older and younger patients
|
Older (Age ≥65 y)
N = 96
|
Younger (Age <65 y)
N = 526
|
P-Value
|
Clinical success
|
|
|
|
Complete, n (%)
|
16 (37)
(n=43)
|
185 (55)
(n=335)
|
0.02
|
Partial, n (%)
|
13 (30)
(n=43)
|
93 (28)
(n=335)
|
Absent, n (%)
|
14 (33)
(n=43)
|
57 (17)
(n=335)
|
Complete biochemical success, n (%)
|
53 (77)
(n = 69)
|
316 (77)
(n = 410)
|
0.96
|
Hyperkalemia (6 or 12 months), n (%)
|
15 (16)
(n = 94)
|
28 (5.5)
(n = 514)
|
0.055
|
Table 3. Comparison of antihypertensive therapies between patients with ADX and MRA
|
Older (Age ≥65 y)
|
Younger (Age <65 y)
|
|
ADX
N = 96
|
MRA
N = 57
|
P-Value
|
ADX
N = 526
|
MRA
N = 176
|
P-Value
|
Baseline
|
|
|
|
|
|
|
Number
|
2 (1-2)
|
1 (1-2)
|
<0.01
|
1 (1-2)
|
1 (1-2)
|
0.28
|
DDD
|
1.5 (1.3-2.4)
|
1.3 (1.0-2.0)
|
0.14
|
1.3 (1.0-2.0)
|
1.3 (1.0-2.0)
|
0.31
|
6 or 12 months (after ADX or MRA)
|
Number
|
1 (1-2)
|
2 (2-3)
|
<0.01
|
1 (0-1)
|
2 (2-2)
|
<0.01
|
DDD
|
1.0 (1.0-1.5)
(n = 68)
|
2.0 (1.0-2.5)
|
<0.01
|
0 (0-1.0)
(n = 432)
|
2.0 (1.0-3.0)
|
<0.01
|
DDD (MRA)
|
-
|
1.0 (0.7-2.0)
|
-
|
-
|
1.0 (0.7-2.0)
|
0.88
|
DDD
(Except for MRA)
|
1.0 (0-1.5)
(n = 68)
|
0.3 (0-1.0)
|
0.03
|
0 (0-1.0)
(n = 432)
|
0.5 (0-1.3)
|
0.01
|
MRA
|
|
|
|
|
|
|
Spironolactone, n (%)
|
-
|
16 (28)
|
-
|
-
|
59 (34)
|
0.44
|
Eplerenone, n (%)
|
-
|
41 (72)
|
-
|
-
|
117 (66)
|
|
ARB/ACE-I, n (%)
|
18 (19)
|
5 (8.8)
|
0.11
|
68 (13)
|
28 (16)
|
0.32
|
CCB, n (%)
|
75 (78)
|
46 (81)
|
0.70
|
281 (53)
|
132 (75)
|
<0.01
|
Diuretics, n (%)
|
1 (1.0)
|
1 (1.8)
|
0.71
|
2 (2.3)
|
4 (2.3)
|
0.99
|
Alfa-blocker, n (%)
|
10 (10)
|
7 (12)
|
0.72
|
39 (7.4)
|
16 (9.1)
|
0.52
|
Beta-blocker, n (%)
|
8 (8.3)
|
3 (5.3)
|
0.48
|
23 (4.4)
|
10 (5.7)
|
0.48
|
Values are median (interquartile range), or n (%). The p-values of DDD and kinds of MRA represent the comparison between older and younger patients treated with MRA. ACE-I, angiotensin converting enzyme inhibitor; ADX, adrenalectomy; ARB, angiotensin II receptor blocker; CCB, calcium channel blocker; DDD, defined daily dose.
Table 4. Differences in the percentage change of eGFR with ADX compared to that with MRA in generalized linear models with or without the use of IPTW
|
Older
|
Younger
|
P-value for interaction
|
|
Mean
|
95% CI
|
P-value
|
Mean
|
95% CI
|
P-value
|
From baseline to 36 months, %
|
|
|
|
|
|
|
|
non-adjusted
|
-19.4
|
-26.2 to -12.6
|
<0.001
|
-5.95
|
-9.55 to -2.34
|
0.001
|
<0.001
|
IPTW-adjusted
|
-17.0
|
-24.3 to -9.6
|
<0.001
|
-4.70
|
-8.48 to -0.92
|
0.015
|
0.003
|
From baseline to 6 months, %
|
|
|
|
|
|
|
|
non-adjusted
|
-11.4
|
-19.8 to -3.0
|
0.008
|
-8.01
|
-11.7 to -4.36
|
<0.001
|
0.440
|
IPTW-adjusted
|
-7.20
|
-15.9 to 1.5
|
0.107
|
-6.12
|
-10.4 to -1.83
|
0.005
|
0.132
|
From 6 to 36 months, %
|
|
|
|
|
|
|
|
non-adjusted
|
-7.90
|
-14.4 to -1.40
|
0.017
|
2.87
|
-0.95 to 6.70
|
0.141
|
0.013
|
IPTW-adjusted
|
-9.44
|
-16.1 to -2.75
|
0.006
|
2.10
|
-2.67 to 6.87
|
0.389
|
0.011
|
Gender, age, body mass index, SBP, log-transformed PAC, eGFR, DDD of antihypertensives, and the presence of hypokalemia at baseline were used as covariates. Standardized differences of each covariate between the treatments before (unadjusted) and after the adjustment with IPTW (IPTW-adjusted) are as follows: Gender, 0.10 and 0.01; age, 0.35 and 0.02; body mass index, 0.17 and 0.05; SBP, 0.24 and 0.01; log-transformed PAC, 0.54 and 0.03; eGFR, 0.15 and 0.05; the DDD of antihypertensives, 0.06 and 0.04; the presence of hypokalemia, 0.50 and 0.00, respectively. P-value for the interaction between the age groups and the treatment choices (ADX or MRA). ADX, adrenalectomy; CI, confidence interval; DDD, daily defined dose, eGFR, estimated glomerular filtration rate; IPTW, inverse probability of treatment weighting; MRA, mineralocorticoid receptor antagonist; PAC, plasma aldosterone concentration; SBP, systolic blood pressure.