A3370 The outcome comparisons of patients with primary aldosteronism and resistant hypertension after adrenalectomy or medical treatment

Objectives: Patients with resistant hypertension usually benefit from add-on spironolactone treatment. The aim of this study is to understand the outcome of patients with both primary aldosteronism (PA) and resistant hypertension after either adrenalectomy or medical treatment, namely add-on spironolactone treatment. Methods: This is a retrospective study including 510 hospitalized patients who were diagnosed with primary aldosteronism from 2013 to 2016. Results: 120 of 510 patients (23.5%) with PA were also resistant hypertensives. 42 of them underwent unilateral adrenalectomy and 78 patients received medical treatment. The surgery group and medical treatment group had similar baseline characteristics. During follow-up, surgery group had less medication use than the medical treatment group (3.36 ± 0.87 vs 1.84 ± 1.52, P = 0.001) as well as the office systolic blood pressure (136 ± 15 vs 129 ± 6 mmHg, P = 0.02). The dosage of spironolactone in the medical treatment group was 33 ± 16 mg. 54.6% patients of medical treatment group and 20% patient of surgery group were still resistant hypertensives (P = 0.005). Baseline smoking status and body mass index (BMI) were significantly different between resistant patients and non-resistant patients. Conclusion: More than half of patients with PA and resistant hypertension remained resistant status after spironolactone add-on treatment. Unilateral adrenalectomy is therefore encouraged when patients with PA had surgery indication.