Why the study?
Hypertension does not always improve after adrenalectomy for primary aldosteronism and antihypertensive medications cannot always be discontinued, motivating the identification of prognostic predictors of hypertension following surgery.
Do hypertension duration, metabolic syndrome, and preoperative antihypertensive dose predict clinical success (normal blood pressure without medications) after adrenalectomy in patients with primary aldosteronism?
Do hypertension duration, metabolic syndrome, and preoperative antihypertensive dose predict clinical success (normal blood pressure without medications) after adrenalectomy in patients with primary aldosteronism?
Longer hypertension duration, presence of metabolic syndrome-related diseases, and higher preoperative defined daily dose of antihypertensives predict a lower likelihood of discontinuing blood pressure medications after adrenalectomy for primary aldosteronism.
May identify patients likely to have persistent hypertension after adrenalectomy; leaves open validation before informing selection or counseling.
BACKGROUND/AIM: Hypertension does not always improve after adrenalectomy for primary aldosteronism (PA), and antihypertensive medications cannot always be discontinued. This study aimed to identify the prognostic predictors of hypertension following adrenalectomy for PA. PATIENTS AND METHODS: This retrospective cohort study included patients undergoing adrenalectomy for PA between 2008 and 2022 at a tertiary hospital, grouping them based on whether they had normal blood pressure without antihypertensive medications or still required medications postoperatively. Age, sex, body mass index (BMI), biochemical data, hypertension duration, pre- and post-operative defined daily dose (DDD) of antihypertensive drugs, presence of metabolic syndrome (MetS)-related diseases, and visceral fat area and volume (recorded using preoperative abdominal computed tomography) were the outcome measures. RESULTS: A total of 71 (clinical success, n=21) (nonclinical success, n=50) patients were included. A high BMI (p=0.038), DDD (p=0.008), and visceral fat volume (p=0.048); long hypertension duration (p=0.034); and the presence of MetS-related diseases (p=0.014) were associated with a low clinical success rate on univariate analyses. After adjusting for age and sex, hypertension duration (p=0.047), MetS-related diseases (p=0.021), and DDD (p=0.011) were potential prognostic predictors. CONCLUSION: Hypertension duration, MetS-related diseases, and DDD are potential prognostic predictors of hypertension following surgery for PA.
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Mitsunari et al. (2024) studied this question.
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