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Primary Aldosteronism

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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) (⊕ )

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