Long-term blood pressure control in patients undergoing adrenalectomy for primary hyperaldosteronism.

Data on long-term blood pressure (BP) control after adrenalectomy for primary hyperaldosteronism are limited. We analyzed long-term outcomes to identify factors predictive of cure. We performed a retrospective cohort study of patients undergoing adrenalectomy for primary hyperaldosteronism (1997-2013). BP and antihypertensive medications were assessed at long-term follow-up (≥ 12 months). Primary outcome was cure, defined as normotension off antihypertensives. Of 85 patients, 15.3% (n = 13) were cured, 54.1% (n = 46) were normotensive while remaining on anti-hypertensives, and 30.6% (n = 26) were hypertensive. Younger age (P = .011), female sex (P < .001), lesser body mass index (P = .018), shorter duration of hypertension (P = .002), lower creatinine (P = .001), and fewer preoperative antihypertensive medications (P < .001) were associated with cure. Female sex, body mass index ≤ 25 kg/m(2), hypertension <5 years, creatinine ≤ 0.8 mg/dL, and <2 antihypertensives were incorporated into a scoring system. For a score of 0-1 (n = 61) the cure rate was 3%; 100% of patients with a score of 4-5 (n = 3) were cured. This scoring system performed comparably to the Aldosterone Resolution Score, which has been used to evaluate short-term postoperative outcomes. This is the largest study to identify factors associated with long-term BP control after adrenalectomy and incorporate these into a scoring system. These data provide a potential tool to guide preoperative patient counseling.

Wachtel H ，Cerullo I ，Bartlett EK ，Kelz RR ，Cohen DL ，Karakousis GC ，Roses RE ，Fraker DL ... -  《-》

Urinary aldosterone-to-active-renin ratio: a useful tool for predicting resolution of hypertension after adrenalectomy in patients with aldosterone-producing adenomas.

Mourad JJ ，Girerd X ，Milliez P ，Lopez-Sublet M ，Lejeune S ，Safar ME ... -  《AMERICAN JOURNAL OF HYPERTENSION》

Factors affecting complete hypertension cure after adrenalectomy for aldosterone-producing adenoma: outcomes in a large series.

The purpose of this study was to evaluate the impact of hypokalemia on hypertension outcomes in patients with aldosterone-producing adenoma (APA) after adrenalectomy and to determine the factors affecting complete hypertension cure in a large series. Characteristics from 376 APA patients treated with adrenalectomy between 2005 and 2011 were collected from our center. Factors affecting complete hypertension cure were assessed using logistic regression. At the end of follow-up, 207 (55.05%) patients were completely cured, whereas 138 (36.7%) patients were improved, and 31 (8.3%) patients remain refractory. Age (p = 0.028), >2 antihypertensive agents (p < 0.001), duration of hypertension (p < 0.001), duration of hypokalemia (p = 0.037), systolic blood pressure (p = 0.016), and level of plasma aldosterone (p < 0.001) were associated with hypertension outcomes in univariate analysis. However, multivariate logistic regression analysis showed that only duration of hypertension ≥6 years (OR = 0.496, 95% CI 0.323-0.762, p = 0.001) and level of plasma aldosterone ≥35 ng/dl (OR = 0.503, 95% CI 0.326-0.776, p = 0.002) were the significantly independent factors affecting complete hypertension cure. This is the largest series to show that only duration of hypertension and level of plasma aldosterone were the factors affecting complete hypertension cure after adrenalectomy for APA. This study highlights the importance of early diagnosis and early adrenalectomy.

Zhang X ，Zhu Z ，Xu T ，Shen Z ... -  《-》

Aldosteronoma resolution score predicts long-term resolution of hypertension.

The Aldosteronoma Resolution Score (ARS) takes into consideration four, readily available, preoperative clinical parameters in predicting the likelihood of resolution of hypertension in patients 6 months after undergoing unilateral adrenalectomy for aldosterone-producing adenoma (APA). We sought to determine the durability of this predictive model after 1 year. Sixty patients who underwent unilateral adrenalectomy for APA at a single institution between 2004 and 2013 were reviewed retrospectively. Patients who were normotensive without any antihypertensive medication requirement at greater than 1-year follow-up were considered to have complete resolution of hypertension. Forty-seven patients had data available for analysis. Median follow-up was 1,135 days (371-3,202). Forty-five percent of patients had complete resolution, 45% had improvement, and 10% had no improvement in hypertension. Applying the ARS, we found there was complete resolution of hypertension in 73% of patients with ARS 4-5, 53% of patients with ARS 2-3, and 24% of patients with ARS 0-1 compared with 75% (P = .9), 46% (P = .66), and 28% (P = .76), respectively, in the original cohort used to create the ARS. Most patients (90%) have long-term improvement or complete resolution of hypertension after unilateral adrenalectomy for APA. The ARS predicts accurately a patient's likelihood of complete resolution of hypertension beyond 1 year.

Aronova A ，Gordon BL ，Finnerty BM ，Zarnegar R ，Fahey TJ 3rd ... -  《-》

Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients.

Rossi GP ，Bolognesi M ，Rizzoni D ，Seccia TM ，Piva A ，Porteri E ，Tiberio GA ，Giulini SM ，Agabiti-Rosei E ，Pessina AC ... -  《-》