Development of a novel nomogram to predict hypertension cure after laparoscopic adrenalectomy in patients with primary aldosteronism.
BACKGROUND
Primary aldosteronism is the most common curable cause of secondary hypertension. Despite resection, however, many patients with primary aldosteronism continue to require antihypertensive drugs to control their blood pressure. Although many patients with primary aldosteronism want to know the postoperative probability of hypertension cure before surgery, there are no predictive models calculating its probability. We therefore developed a nomogram to predict hypertension cure in patients with primary aldosteronism after laparoscopic adrenalectomy.


METHODS
We retrospectively surveyed 132 Japanese patients with primary aldosteronism who were treated by unilateral laparoscopic adrenalectomy. Hypertension cure was defined as normal blood pressure (<140/90 mmHg) without antihypertensive drugs 6 months postoperatively. We developed a novel nomogram that postoperatively predicted cured hypertension in 105 (80 %) randomly selected patients and validated it with the remaining 27 (20 %).


RESULTS
At 6 months, blood pressure had normalized in 42 % of patients without antihypertensive drugs. Duration of hypertension, preoperative number of antihypertensive drug classes, age, and sex were incorporated into a novel nomogram as independent predictors of hypertension cure. The value of the area under the receiver operating characteristics curve for this nomogram was 0.83-which was significantly higher than that of the Aldosteronoma Resolution Score-on internal validation.


CONCLUSIONS
We developed the first nomogram that can accurately predict postoperative hypertension cure in patients with primary aldosteronism. This nomogram can help clinicians calculate the probability of postoperative hypertension cure in patients with primary aldosteronism and objectively inform them of their hypertension outcome before laparoscopic adrenalectomy.
Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan, takanobu.utsumi@med.tohou.ac.jp.
Takanobu
T
Utsumi
Naoto
N
Kamiya
Takumi
T
Endo
Masashi
M
Yano
Shuichi
S
Kamijima
Koji
K
Kawamura
Takashi
T
Imamoto
Yukio
Y
Naya
Tomohiko
T
Ichikawa
Hiroyoshi
H
Suzuki
D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001794:Blood Pressure; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000601:surgery*; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D007564:Japan; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome