Primary Aldosteronism Surgery Outcomes Under Current Blood Pressure Guidelines

Area of Science:

• Endocrinology
• Surgical Oncology
• Hypertension Management

Background:

• Historical studies reported 37% complete clinical success after adrenalectomy for primary aldosteronism (PA) using a blood pressure (BP) threshold of <140/90 mmHg.
• Current hypertension guidelines utilize a stricter BP threshold of <130/80 mmHg.

Purpose of the Study:

• To evaluate clinical outcomes following adrenalectomy for PA using current BP guidelines.
• To compare success rates with historical data based on older BP thresholds.

Main Methods:

• Retrospective cohort study of 1079 adult patients undergoing adrenalectomy for PA (2013-2024).
• Inclusion criteria: preoperative plasma aldosterone, ambulatory BP measurements pre- and post-adrenalectomy (6-18 months).
• Exclusion: patients with pre-adrenalectomy BP < 130/80 mmHg without antihypertensive therapy.

Main Results:

• Complete clinical success (BP < 130/80 mmHg without medications) was 16.5%.
• Partial clinical success (improved BP control and/or reduced medications) was 73.5%.
• Combined complete and partial success was 90%. Predictors of absent complete success included more preoperative antihypertensive medications, higher social vulnerability, and higher baseline BP.

Conclusions:

• Adrenalectomy for PA yields meaningful clinical outcomes, with 90% achieving complete or partial success under current BP guidelines.
• Complete clinical success rates are lower than previously reported due to the application of stricter BP targets.