Vascular remodeling (media:lumen ratio) and duration of hypertension significantly predicted blood pressure response to adrenalectomy, which provided cure of hypertension in 30% of patients.
Cohort (n=50)
Yes
Do vascular remodeling and duration of hypertension predict blood pressure response to adrenalectomy in patients with aldosterone-producing adenoma?
Longer duration of hypertension and presence of vascular remodeling predict a lower likelihood of blood pressure normalization after adrenalectomy for primary aldosteronism, highlighting the need for early diagnosis.
Remodeling of the resistance arteries is a hallmark of arterial hypertension and predicts cardiovascular events, but it was unknown whether it could also predict the blood pressure response to adrenalectomy of patients with an aldosterone-producing adenoma. Therefore, we investigated the outcome of adrenalectomy as a function of vascular remodeling in the context of the preoperative features of aldosterone-producing adenoma patients. At 2 referral centers for hypertension, we prospectively measured the media:lumen ratio of small arteries from fat tissue of 50 consecutive aldosterone-producing adenoma patients treated with adrenalectomy. The blood pressure response to adrenalectomy was assessed by considering the blood pressure values and the number and dosages of antihypertensive medications. Adrenalectomy significantly (P<0.001) lowered plasma aldosterone (from 27.3+/-4.9 ng/dL to 8.3+/-11.2 ng/dL), the aldosterone:renin ratio (from 117+/-35 to 11+/-2), and blood pressure (from 163+/-22/98+/-2 mm Hg to 133+/-2/84+/-1 mm Hg), even despite a reduction (from 141+/-14 to 100+/-15; P=0.02) of the score of antihypertensive treatment. It provided cure of hypertension in 30% of the aldosterone-producing adenoma patients, normotension with less antihypertensive therapy in 52%, and improved blood pressure control in the rest. The media:lumen ratio and the known duration of hypertension significantly predicted the blood pressure response to adrenalectomy at univariate and multivariate analyses. Because a long duration of hypertension and/or the presence of vascular remodeling imply lower chances of blood pressure normalization at long-term follow-up postadrenalectomy, these findings emphasize the importance of an early diagnosis of aldosterone-producing adenoma.
Rossi et al. (Tue,) conducted a cohort in Primary aldosteronism (aldosterone-producing adenoma) (n=50). Vascular remodeling (media:lumen ratio) and duration of hypertension was evaluated on Blood pressure response to adrenalectomy. Vascular remodeling (media:lumen ratio) and duration of hypertension significantly predicted blood pressure response to adrenalectomy, which provided cure of hypertension in 30% of patients.