Primary Aldosteronism: Factors Associated with Normalization of Blood Pressure after Surgery

  1. Anna M. Sawka, MD;
  2. William F. Young, Jr., MD;
  3. Geoffrey B. Thompson, MD;
  4. Clive S. Grant, MD;
  5. David R. Farley, MD;
  6. Cynthia Leibson, PhD; and
  7. Jon A. van Heerden, MD
  1. From the Mayo Clinic and Mayo Foundation, Rochester, Minnesota.

    Abstract

    Background: Hypertension often persists after adrenalectomy for primary aldosteronism.

    Objective: To determine factors associated with resolution of hypertension after adrenalectomy for primary aldosteronism.

    Design: Retrospective cohort study.

    Setting: Tertiary care referral center in Rochester, Minnesota.

    Patients: All patients who underwent adrenalectomy for primary aldosteronism between 1 January 1993 and 31 December 1999.

    Measurements: Preoperative plasma renin activity, plasma and urinary aldosterone concentrations, and adrenal imaging. Follow-up blood pressure, measured at a clinic visit or at home, was reviewed.

    Results: 97 adrenalectomies were performed, and follow-up was available in 93 patients. Hypertension was resolved at follow-up (blood pressure < 140/90 mm Hg) without use of antihypertensive agents in 31 of 93 patients (33%). According to a stepwise multivariable logistic regression analysis adjusted for duration of follow-up, resolution of hypertension was independently associated with family history of hypertension in no more than 1 first-degree relative (odds ratio [OR], 10.9; P < 0.001) and preoperative use of two or fewer antihypertensive agents (OR, 4.7; P = 0.005). Additional factors associated with resolution of hypertension based on univariate analysis included younger age, shorter duration of hypertension, higher preoperative ratio of plasma aldosterone concentration to plasma renin activity, and higher urine aldosterone level (P < 0.05).

    Conclusions: Resolution of hypertension after adrenalectomy for primary aldosteronism is independently associated with a lack of family history of hypertension and preoperative use of two or fewer antihypertensive agents.

    Article and Author Information

    • Acknowledgments: The authors thank Ms. Kathleen Curlee for assistance with telephone follow-up and the staff of the Mayo Center for Patient-Oriented Research for assistance with statistical analysis.

    • Requests for Single Reprints: William F. Young Jr., MD, Division of Endocrinology, Metabolism, and Nutrition, and Division of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

    • Current Author Addresses: Drs. Sawka, Young, Thompson, Grant, Farley, Leibson, and van Heerden: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

    • Author Contributions: Conception and design: A.M. Sawka, W.F. Young.

    • Analysis and interpretation of the data: A.M. Sawka, W.F. Young, C.S. Grant.

    • Drafting of the article: A.M. Sawka, W.F. Young, C. Leibson.

    • Critical revision of the article for important intellectual content: A.M. Sawka, W.F. Young, G.B. Thompson, C.S. Grant, D.R. Farley, C. Leibson, J.A. van Heerden.

    • Final approval of the article: A.M. Sawka, W.F. Young, G.B. Thompson, C.S. Grant, D.R. Farley, C. Leibson, J.A. van Heerden.

    • Provision of study materials or patients: W.F. Young, G.B. Thompson, C.S. Grant, D.R. Farley.

    • Statistical expertise: A.M. Sawka.

    • Collection and assembly of data: A.M. Sawka, W.F. Young.

    Summary for Patients

    • Summaries for Patients:Factors Associated with Normal Blood Pressure after Surgery To Treat Primary Aldosteronism Ann Intern Med August 21, 2001 135:S32
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    1. Ann Intern Med August 21, 2001 vol. 135 no. 4 258-261
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