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

Abstract 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. 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. 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). 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.