Does Surgery for Primary Hyperaldosteronism Address Secondary Hypertension?
While primary hyperaldosteronsim (PHA) can often cause secondary hypertension, it is possible to cure the hypertension—if there is a unilateral adenoma causing the PHA. If that is the case, then the tumor can be removed with surgery. Researchers from Germany looked at the clinical parameters that predict hypertension resolution following laparascopic adrenalectomy.
The results were published in the November 2011 issue of World Journal of Surgery; the article is “Outcome of surgery for primary hyperaldostersonism.”
The authors identified all PHA patients who underwent laparascopic adrenalectomy in their department between 1993 and 2009. They then examined the patients’ charts and follow-up data, looking specifically at clinical parameters and hormone levels, and they performed univariate and multivariate analysis with SPSS 15.0.
Of the 54 patients in the cohort (30 female, 24 male), hypokalemia was seen in 47 of them (87%).
Without any further need of antihypertensive medications, 20 patients (37%) were cured. Another 20 patients (37%) saw an improvement in hypertension following laparascopic adrenalectomy. There were 14 patients (26%) who were unaffected. In total, then, hypertension was either resolved or improved in 40 out of 54 of the patients (74%).
The independent predictors of hypertension resolution in a multivariate analysis were:
- shorter duration of hypertension (< 6 years)
- fewer antihypertensive drugs (< 3)
- serum creatinine levels < 1.3 mmol/L
There was a final follow-up after a mean of 49±40 months; then, hypertension resolution was observed in 17 out of 30 patients (57%).
It’s interesting to note that 10 out of 17 patients, a period longer than 12 months was needed before hypertension resolution was observed. Also, coexistent hyperplasia (which was seen in 30% of the patients) didn’t correlate with outcome.
The authors concluded that in 50% of patients with PHA, laparascopic adrenalectomy will resolve secondary hypertension. However, that may require more than 12 months.
There is a higher risk of persistent hypertension following surgery if a patient has had hypertension for more than 6 years, is on more than 3 antihypertensive drugs, and has an elevated serum creatinine level.