Primary aldosteronism: Factors associated with normalization of blood pressure after surgery

Background: Hypertension often persists after adrenalectomy for primary ald osteronism. 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 aldosteronis m between I January 1993 and 31 December 1999. Measurements: Preoperative plasma renin activity, plasma and urinary aldost erone concentrations, and adrenal imaging. Followup blood pressure, measure d 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 < 140/9 0 mm Hg) without use of antihypertensive agents in 31 of 93 patients (33%). According to a stepwise multivariable logistic regression analysis adjuste d for duration of follow-up, resolution of hypertension was independently a ssociated with family history of hypertension in no more than 1 first-degre e relative (odds ratio [OR], 10.9; P < 0.001) and preoperative use of two o r fewer antihypertensive agents (OR, 4.7; P = 0.005). Additional factors as sociated with resolution of hypertension based on univariate analysis inclu ded younger age, shorter duration of hypertension, higher preoperative rati o of plasma aldosterone concentration to plasma renin activity, and higher urine aldosterone level (P < 0.05). Conclusions: Resolution of hypertension after adrenalectomy for primary ald osteronism is independently associated with a lack of family history of hyp ertension and preoperative use of two or fewer anti hypertensive agents.