Association of kidney function with residual hypertension after treatment of aldosterone-producing adenoma.
BACKGROUND
Autonomous secretion of aldosterone in patients with primary aldosteronism increases glomerular filtration rate and causes kidney damage. The influence of a mild decrease in kidney function on residual hypertension after adrenalectomy is unexplored.


METHODS
Nonconcurrent prospective study.


METHODS
The study was based on the Taiwan Primary Aldosteronism Investigation (TAIPAI) database. 150 patients (61 men; overall mean age, 47.2 +/- 11.6 years) with a diagnosis of aldosterone-producing adenoma had undergone unilateral adrenalectomy at National Taiwan University Hospital from July 1999 to January 2007.


METHODS
Presurgery estimated glomerular filtration rate (eGFR).


METHODS
Residual hypertension after adrenalectomy, defined either as less than 75% of recorded blood pressure measurements with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg or requiring antihypertensive medications during the first year after surgery.


RESULTS
Before surgery, 27 (18%), 72 (48%), and 51 (34%) patients had moderately to severely decreased (<60 mL/min/1.73 m(2)), mildly decreased (60 <or= eGFR < 90 mL/min/1.73 m(2)), or nondecreased eGFR (>or=90 mL/min/1.73 m(2)), respectively. After surgery, 16 (59.3%), 29 (40.3%), and 10 (19.3%) patients in each category had postsurgery residual hypertension. Compared with patients without decreased eGFR before surgery, adjusted odds ratios for postsurgery residual hypertension were 2.7 (95% confidence interval, 1.03 to 7.0; P = 0.04) and 2.8 (95% confidence interval, 1.05 to 9.3) for mildly and moderately to severely decreased eGFR, respectively.


CONCLUSIONS
Arbitrary definition for residual hypertension.


CONCLUSIONS
Two-thirds of patients with aldosterone-producing adenoma were cured of hypertension by means of unilateral adrenalectomy. Kidney function impairment, even mild, appears to be associated with a high incidence of postsurgery residual hypertension.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Wu
Vin-Cent
VC
Chueh
Shih-Chieh
SC
Chang
Hung-Wei
HW
Lin
Lian-Yu
LY
Liu
Kao-Lang
KL
Lin
Yen-Hung
YH
Ho
Yi-Luwn
YL
Lin
Wei-Chou
WC
Wang
Shuo-Meng
SM
Huang
Kuo-How
KH
Hung
Kuan-Yu
KY
Kao
Tze-Wah
TW
Lin
Shuei-Liong
SL
Yen
Ruoh-Fang
RF
Chen
Yung-Ming
YM
Hsieh
Bor-Sen
BS
Wu
Kwan-Dun
KD
D000236:Adenoma / Q000097:blood / Q000150:complications / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery; D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000150:complications / Q000378:metabolism / Q000503:physiopathology* / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D000450:Aldosterone / Q000097:blood* / Q000378:metabolism; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D006973:Hypertension / Q000097:blood / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000450:Aldosterone; D003404:Creatinine