Essential hypertension: First reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism?

Background. Despite cure of primary aldosteronism by surgical resection, hy pertension persists postoperatively in 30 % to 50 % of patients. The aim of this study was to determine factors influencing long-term outcome of blood pressure after unilateral adrenalectomy for primary aldosteronism. Methods. Records of 100 patients who underwent unilateral adrenalectomy for primary aldosteronism from 1970 through 1997 were reviewed. Patients were distributed in 2 groups according to whether blood pressure was normal (cri teria of World Health Organization). Clinical, biochemical, and pathologic data were compared. Results. All patients were biochemically cured. Blood pressure was normal i n 56 patients and improved in 44 (mean follow-up, 69 and 59 months). Persis tent hypertension correlated with age, known duration and seriousness of pr eoperative hypertension, family history of hypertension, no preoperative re sponse to spironolactone, and contralateral adrenal hypertrophy. Gender sur gical approach, and pathologic findings were not predictive factors of bloo d pressure outcome. The prevalence of hypertension was almost the same in t hese postoperative patients as the prevalence of essential hypertension in a random population of the same age. Conclusions. Early unilateral adrenalectomy allows cure or improvement of h ypertension in all patients with primary aldosteronism induced by unilatera l excessive source of aldosterone secretion regardless of the pathologic fi ndings. Persistent hypertension suggests that coexisting essential hyperten sion is present.