Pathology of the adrenal gland in refractory low-renin hypertension

The adrenal glands of 13 patients with low-renin hypertension that was refractory to medical treatment were examined. Eight patients underwent total adrenalectomies and five underwent subtotal adrenalectomies. All of these patients had grossly visible adrenocortical changes. Ten patients had gross cortical nodules, and ten showed nonnodular cortical hyperplasia; seven had both. All ten patients with gross nodules had microscopic nodules as well. Of the 13 patients with low-renin hypertension, 12 (92%) had substantially lower blood pressure postoperatively without medication. During a follow-up period ranging from 14 to 38 months, three patients were normotensive without medication, nine patients had lowered blood pressures without medication and were easily maintained normotensive on antihypertensive medication, and one patient had no significant reduction in blood pressure postoperatively and no improvement in blood pressure control with antihypertensive drugs.