Primary aldosteronism: factors associated with normalization of blood pressure after surgery.
BACKGROUND
Hypertension often persists after adrenalectomy for primary aldosteronism.


OBJECTIVE
To determine factors associated with resolution of hypertension after adrenalectomy for primary aldosteronism.


METHODS
Retrospective cohort study.


METHODS
Tertiary care referral center in Rochester, Minnesota.


METHODS
All patients who underwent adrenalectomy for primary aldosteronism between 1 January 1993 and 31 December 1999.


METHODS
Preoperative plasma renin activity, plasma and urinary aldosterone concentrations, and adrenal imaging. Follow-up blood pressure, measured at a clinic visit or at home, was reviewed.


RESULTS
97 adrenalectomies were performed, and follow-up was available in 93 patients. Hypertension was resolved at follow-up (blood pressure < 140/90 mm Hg) without use of antihypertensive agents in 31 of 93 patients (33%). According to a stepwise multivariable logistic regression analysis adjusted for duration of follow-up, resolution of hypertension was independently associated with family history of hypertension in no more than 1 first-degree relative (odds ratio [OR], 10.9; P < 0.001) and preoperative use of two or fewer antihypertensive agents (OR, 4.7; P = 0.005). Additional factors associated with resolution of hypertension based on univariate analysis included younger age, shorter duration of hypertension, higher preoperative ratio of plasma aldosterone concentration to plasma renin activity, and higher urine aldosterone level (P < 0.05).


CONCLUSIONS
Resolution of hypertension after adrenalectomy for primary aldosteronism is independently associated with a lack of family history of hypertension and preoperative use of two or fewer antihypertensive agents.
Sawka
A M
AM
Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Young
W F
WF
Thompson
G B
GB
Grant
C S
CS
Farley
D R
DR
Leibson
C
C
van Heerden
J A
JA
D000236:Adenoma / Q000150:complications / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000032:analysis; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000601:surgery*; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000235:genetics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood; D012189:Retrospective Studies
D000959:Antihypertensive Agents; D000450:Aldosterone; D012083:Renin