13
There are reports of a substantial number of false-negative or equivocal results.
Concerns
Table 8. Summary of Systematic Reviews Addressing
Management of PA
Question Outcomes Studies
Certainty in
Evidence
Adrenalectomy vs.
MR antagonists
Adrenalectomy was
more effective in
reducing BP with no
difference in LV mass
reduction
Four studies
enrolling 355
patients with
long-term followup
(average, 4 y)
BP control
(⊕⊕⊕
);
no difference
in LV mass
reduction
(⊕⊕
)
Prevalence of PA Weighted mean
prevalence of elevated
ARRs and PA in
primary care (prevalence
of high ARRs, 16.5%;
prevalence of PA,
4.3%) and referred
patients (prevalence
of high ARRs, 19.6%;
prevalence of PA, 9.5%)
11 Observational
studies
not available
Accuracy of
CT and MRI in
diagnosing laterality
of aldosterone
secretion (adrenal
vein sampling is the
"gold standard")
Diagnostic accuracy
outcome: in 37.8% of
patients (359 of 950),
CT/MRI results did not
agree with AVS results
38 Observational
studies (950
patients)
(⊕⊕
)
Use of ARR as a
screening test for PA
Diagnostic accuracy
estimates not available
(due to methodological
limitations)
16 Observational
studies (3136
patients)
(⊕
)