Peri-Arterial Neural Dissection During Adrenal Surgery Provides a Denervation-Like Benefit in Hypertension Control

Area of Science:

• Nephrology
• Cardiovascular Surgery
• Endocrinology

Background:

• Peri-arterial neural fibers around the renal artery can increase sympathetic activity, contributing to hypertension.
• Adrenal surgery involves dissecting peri-arterial tissues, potentially mimicking renal denervation.
• The impact of this surgical maneuver on postoperative blood pressure control is not well understood.

Purpose of the Study:

• To investigate whether surgical peri-arterial neural dissection during adrenal surgery improves postoperative blood pressure control in hypertensive patients.
• To assess the effect of this dissection on antihypertensive medication use and renal/adrenal function.

Main Methods:

• Retrospective review of 127 hypertensive patients undergoing adrenal surgery (Jan 2022-Mar 2025).
• Classification into surgical peri-arterial neural dissection or nondissection groups, followed by 1:2 matching (54 patients total).
• Assessment of hypertension remission, changes in medication use (defined daily dose), and comparison of renal/adrenal function markers.

Main Results:

• The dissection group showed a significantly higher hypertension remission rate (50.0% vs. 16.1%, P=0.008).
• Surgical peri-arterial neural dissection was independently associated with lower odds of postoperative nonremission (OR=0.150, P=0.020).
• Patients in the dissection group had greater reductions in antihypertensive medication use (median change -1.0 vs. 0.0, P=0.006), with no significant differences in renal or adrenal function markers.

Conclusions:

• Surgical peri-arterial neural dissection during adrenal surgery is linked to better postoperative blood pressure control.
• The procedure may reduce the need for antihypertensive medications.
• No adverse effects on renal or adrenal function were observed.