Blood pressure and medication changes following adrenalectomy for unilateral primary aldosteronism

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.