OS 35-09 LONG-TERM OUTCOME OF SURGICALLY- AND MEDICALLY-TREATED PATIENTS OF THE PRIMARY ALDOSTERONISM PREVALENCE IN HYPERTENSIVES (PAPY) STUDY.

OBJECTIVE: PA causes excess cardiovascular (CV) damage, but whether it worsens prognosis remained uncertain as there are no prospective studies. To compare long-term outcome of the 1125 patients recruited in the PAPY study.

DESIGN AND METHOD: 11.2% of the PAPY study patients had PA: 6.4% idiopathic hyperaldosteronism (IHA) received medical therapy; 4,8% aldosterone-producing adenoma (APA) required adrenalectomy. Endpoints were total and CV mortality, major adverse cardiovascular events (MACE) and total CV events. Kaplan-Meier and Cox's analysis were used to compare IHA and APA with essential hypertensives (EH). In 2015 outcome data were gathered blindly to final diagnosis.

RESULTS: After 11.9 years (median) 65% of the patients had follow-up data. Overall the baseline features of available patients were similar to those lost at follow-up. Compared to EH, IHA patients showed worse death-free survival (88.6% vs 96.8%; p = 0.015), while adrenalectomized APA patients did not. At multivariate analysis IHA independently predicted overall mortality (hazard ratio: 3.02; 95% CI: 1.03-8.85; p = 0.044).

CONCLUSIONS: With a robust prospective design and the strength of a high power we showed that medically-treated IHA patients remained at a higher risk than EH patients at a long-term follow-up while adrenalectomized APA patients did not. Hence, accurate PA subtyping to achieve early identification of those that need adrenalectomy is key to improve outcome.