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Blood pressure and medication changes following adrenalectomy for unilateral primary aldosteronism: a follow-up study.
MedLine Citation:
PMID:  22252482     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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. CONCLUSION:: 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:
Petra van der Linden; Olivier Steichen; Franck Zinzindohoué; Pierre-François Plouin
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-16
Journal Detail:
Title:  Journal of hypertension     Volume:  -     ISSN:  1473-5598     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8306882     Medline TA:  J Hypertens     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aAP-HP, European Hospital Georges Pompidou, Hypertension Unit bParis Descartes University, Faculty of Medicine cAP-HP, European Hospital Georges Pompidou, Clinical Investigations Center dINSERM, UMR_S 872, Equipe 20 eAP-HP, European Hospital Georges Pompidou, General Surgery, Paris, France *Petra van der Linden and Olivier Steichen contributed equally to the writing of the article.
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