Adrenalectomy reduced antihypertensive medications by 1.11 classes and lowered antihypertensive prescription costs by $908 at 1 year versus medical management in adults with primary aldosteronism.
Observational (n=911)
Does adrenalectomy reduce antihypertensive medication requirements and prescription costs compared to medical management in patients with primary aldosteronism?
Adrenalectomy for primary aldosteronism significantly reduces long-term antihypertensive medication burden and prescription costs compared to medical management.
Effect estimate: β = -1.11 antihypertensive medications; cost reduction β = -908.34 USD (95% CI 95% CI −1.31 to −0.91 medications; 95% CI −1134.86 to −681.81 USD)
Absolute Event Rate: 1.5% vs 2.5%
p-value: p=<0.001
Abstract Background Primary aldosteronism (PA) can be treated surgically or medically depending on disease lateralization and surgical candidacy. There is a dearth of data directly comparing antihypertensive medication trajectories and costs between these strategies. Patients and Methods We performed a retrospective cohort study of patients with new PA diagnoses and adrenal vein sampling to assess antihypertensive medication outcomes and treatment costs using Optum’s de-identified Clinformatics ® Data Mart Database (2004–2022). Patients were stratified by receipt of adrenalectomy versus medical management alone. The index time point was defined as adrenal vein sampling (AVS) for medically managed and adrenalectomy for surgically managed patients. Outcomes were assessed using regression models. Results Of 911 patients, 52% underwent adrenalectomy and 48% medical therapy. Adrenalectomy patients were younger, with higher Elixhauser scores. Antihypertensive medication use (2. 9 versus 2. 8, p = 0. 636) and costs did not differ at index. After 1 year, adrenalectomy patients used fewer antihypertensive medications (1. 5 ± 1. 4) than medically managed patients (2. 5±1. 5, p < 0. 001). On regression, age (β = 0. 02, p = 0. 002), male sex (β = 0. 40, p < 0. 001), and baseline antihypertensive medications (β = 0. 43, p < 0. 001) were associated with higher antihypertensive medication requirement. Adrenalectomy patients were prescribed 1. 11 fewer antihypertensive medications at one year (p < 0. 001). In the resistant hypertension subcohort, adrenalectomy reduced antihypertensive medications by 1. 35 (p < 0. 001). Adrenalectomy was associated with US 908 lower antihypertensive medication prescription costs (p < 0. 001) and 87% lower odds of potassium supplementation (p < 0. 001). Conclusions Patients with PA who undergo adrenalectomy demonstrate a significant reduction in antihypertensive medications compared with medically managed patients. While there is significant upfront cost to surgical intervention, reduced long-term prescription costs are realized.
Passman et al. (2026) conducted an observational in Adults (≥18 years) with newly diagnosed primary aldosteronism who underwent adrenal vein sampling and were either treated with adrenalectomy or medical management (n=911). Adrenalectomy vs. Medical management alone (including mineralocorticoid receptor antagonists) was evaluated on Number of antihypertensive medication classes prescribed at 1 year and cumulative antihypertensive prescription costs (β = -1.11 antihypertensive medications; cost reduction β = -908.34 USD, 95% CI 95% CI −1.31 to −0.91 medications; 95% CI −1134.86 to −681.81 USD, p=<0.001). Adrenalectomy reduced antihypertensive medications by 1.11 classes and lowered antihypertensive prescription costs by $908 at 1 year versus medical management in adults with primary aldosteronism.