title: Blood pressure and medication changes following adrenalectomy for unilateral primary aldosteronism:  a follow-up study.
abstract: OBJECTIVE
  Adrenalectomy for unilateral primary aldosteronism cures hypertension in less than 50% of patients, but improvement is observed in most of the remaining ones. Our goal was to quantify the blood pressure (BP) decrease adjusted for medication changes following adrenalectomy and to identify preoperative predictors of this outcome.
  
  
  METHODS
  We analyzed simultaneous changes in BP and medication by reviewing the records of 156 consecutive patients who had undergone adrenalectomy for unilateral primary aldosteronism in one center between 2001 and 2009 for whom postoperative follow-up data were available.
  
  
  RESULTS
  Median [interquartile range] baseline SBP was 149 [135-160] mmHg on drugs from two [1-3] different classes. After adrenalectomy, SBP decreased by 21 [5-31] mmHg and the number of drug classes administered, by one [0-2]. The decrease in SBP, adjusted for the change in the number of drug classes, was 26 [14-36] mmHg. Each drug class dropped after surgery was equivalent to a 5 mmHg SBP decrease. Patients with higher preoperative BP or serum sodium levels experienced a greater BP decrease after adrenalectomy. Adrenalectomy cured hypertension in 68 (44%) patients. Hypertension was less likely to be cured in patients with a longer history of hypertension, higher preoperative BP levels, larger number of drug classes, or lower urinary aldosterone levels.
  
  
  CONCLUSIONS
  Although patients with severe hypertension are likely to derive considerable benefits from adrenalectomy in terms of BP or treatment reduction, they should be warned that hypertension cure is unlikely.
authors.affiliation: AP-HP, European Hospital Georges Pompidou, Hypertension Unit, Paris, France.
authors.forename: Petra
authors.initials: P
authors.lastname: van der Linden
authors.forename: Olivier
authors.initials: O
authors.lastname: Steichen
authors.forename: Franck
authors.initials: F
authors.lastname: Zinzindohoué
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Plouin
mesh_terms: D000315:Adrenalectomy; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D057915:Drug Substitution; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction
chemical_list: D000959:Antihypertensive Agents