title: Long-term blood pressure control in patients undergoing adrenalectomy for primary hyperaldosteronism.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: heather.wachtel@uphs.upenn.edu.
authors.forename: Heather
authors.initials: H
authors.lastname: Wachtel
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Isadora
authors.initials: I
authors.lastname: Cerullo
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Bartlett
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.affiliation: Division of Renal, Electrolyte, and Hypertension, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Cohen
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Fraker
mesh_terms: D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000601:surgery*; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D016015:Logistic Models; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents