Cause of residual hypertension after adrenalectomy in patients with primary aldosteronism

The cause of residual hypertension after adrenalectomy for primary aldoster onism (PA) is unknown. The purpose of this study is to investigate the char acteristic pathological kidney features associated with PA. Between 1977 an d 1999 at our hospital, 26 patients with PA caused by a unilateral adrenal cortical adenoma (Conn's syndrome) underwent unilateral adrenalectomy with concurrent open-wedge renal biopsy. Patients were categorized into two grou ps: (1) those with normotension with diastolic blood pressure less than 90 mm Hg who were not administered antihypertensive drugs, and (2) those with residual hypertension with diastolic blood pressure of 90 mm Hg or greater who were administered medication for 6 months after surgery. Thirteen patie nts were cured of hypertension postoperatively, and 12 patients were admini stered antihypertensive medications. Glomerulosclerosis, renal arterioloscl erosis, and preoperative left ventricular mass (LVM) index were worse in th e group with residual hypertension than in that with normotension (17.8% +/ - 7.8% versus 9.6% +/- 3.8%; P = 0.01; 2.5 +/- 0.5 versus 1.6 +/- 0.4, Bade r's grade; P = 0.005; and 165 +/- 31 versus 139 +/- 24 g/m(2); P = 0.02, re spectively), Severity of tubulointerstitial injury, preoperative duration o f hypertension, preoperative severity of proteinuria, plasma aldosterone le vel, and serum potassium concentration were not significantly different bet ween the two groups. In conclusion, severity of glomerulosclerosis and arte riolosclerosis and LVM are related to blood pressure after adrenalectomy in patients with PA. (C) 2001 by the National Kidney Foundation, Inc.