Key result
Higher BMI linked to ~78% lower odds of hypertension resolution after adrenalectomy for primary hyperaldosteronism.
Why the study?
The influence of obesity on the efficacy of adrenalectomy in primary hyperaldosteronism had not been established.
Does unilateral adrenalectomy improve blood pressure and reduce anti-hypertensive medication burden in patients with primary hyperaldosteronism, and how does obesity impact this?
Cohort (n=53)
No
Does unilateral adrenalectomy improve blood pressure and reduce anti-hypertensive medication burden in patients with primary hyperaldosteronism, and how does obesity impact this?
Effect estimate: OR 4.56 (95% CI 1.18-20.6)
p-value: p=<0.01
Unilateral adrenalectomy improves hypertension and hypokalemia in primary hyperaldosteronism, but obesity independently reduces the likelihood of complete hypertension resolution, necessitating continued anti-hypertensive therapy.
Obesity may necessitate continued antihypertensives after adrenalectomy; leaves open whether weight loss augments resolution rates.
BACKGROUND: This study aims to determine the impact of patient obesity on the resolution of hypertension and pill burden post-adrenalectomy for PA. Primary hyperaldosteronism (PA) is the most common cause of secondary hypertension that may be remedied with surgery (unilateral adrenalectomy). Obesity may independently cause hypertension through several mechanisms including activation of the renin-angiotensin-aldosterone pathway. The influence of obesity on the efficacy of adrenalectomy in PA has not been established. METHODS: This is a retrospective analysis of prospectively collected data on patients undergoing adrenalectomy for PA at a single, tertiary-care surgical centre from January 2015 to December 2020. Electronic health records of patients were screened to collect relevant data. The primary outcomes of the study include post-operative blood pressure, the reduction in the number of anti-hypertensive medications and potassium supplementation burden post-adrenalectomy. RESULTS: Fifty-three patients were included in the final analysis. There was a significant reduction in the blood pressure and the number of anti-hypertensive medications in all patients after adrenalectomy (p < 0.001). Of the 34 patients (64.2%) with pre-operative hypokalaemia, all became normokalaemic and were able to stop supplementation. However obese patients required more anti-hypertensive medications to achieve an acceptable blood pressure than overweight or normal BMI patients (p < 0.01). Multivariate logistic regression analysis showed that male gender and BMI were independent predictors of resolution of hypertension (p <0.01). CONCLUSION: Unilateral adrenalectomy improves the management of hypertension and hypokalaemia when present in patients with PA. However, obesity has an independent deleterious impact on improvement in blood pressure post-adrenalectomy for PA.
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Chidambaram et al. (2023) conducted a cohort in Primary hyperaldosteronism (n=53). Unilateral adrenalectomy vs. Normal or overweight BMI was evaluated on Resolution of hypertension (cure) (OR 4.56, 95% CI 1.18-20.6, p=<0.01). Higher body mass index independently reduced the likelihood of hypertension resolution following unilateral adrenalectomy for primary hyperaldosteronism (OR 4.56).
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