Wu Vin-Cent, Chueh Shih-Chieh, Chang Hung-Wei, Lin Lian-Yu, Liu Kao-Lang, Lin Yen-Hung, Ho Yi-Luwn, Lin Wei-Chou, Wang Shuo-Meng, Huang Kuo-How, Hung Kuan-Yu, Kao Tze-Wah, Lin Shuei-Liong, Yen Ruoh-Fang, Chen Yung-Ming, Hsieh Bor-Sen, Wu Kwan-Dun
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Am J Kidney Dis. 2009 Oct;54(4):665-73. doi: 10.1053/j.ajkd.2009.06.014. Epub 2009 Jul 23.
Autonomous secretion of aldosterone in patients with primary aldosteronism increases glomerular filtration rate and causes kidney damage. The influence of a mild decrease in kidney function on residual hypertension after adrenalectomy is unexplored.
Nonconcurrent prospective study.
SETTING & PARTICIPANTS: The study was based on the Taiwan Primary Aldosteronism Investigation (TAIPAI) database. 150 patients (61 men; overall mean age, 47.2 +/- 11.6 years) with a diagnosis of aldosterone-producing adenoma had undergone unilateral adrenalectomy at National Taiwan University Hospital from July 1999 to January 2007.
Presurgery estimated glomerular filtration rate (eGFR).
OUTCOMES & MEASUREMENTS: Residual hypertension after adrenalectomy, defined either as less than 75% of recorded blood pressure measurements with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg or requiring antihypertensive medications during the first year after surgery.
Before surgery, 27 (18%), 72 (48%), and 51 (34%) patients had moderately to severely decreased (<60 mL/min/1.73 m(2)), mildly decreased (60 <or= eGFR < 90 mL/min/1.73 m(2)), or nondecreased eGFR (>or=90 mL/min/1.73 m(2)), respectively. After surgery, 16 (59.3%), 29 (40.3%), and 10 (19.3%) patients in each category had postsurgery residual hypertension. Compared with patients without decreased eGFR before surgery, adjusted odds ratios for postsurgery residual hypertension were 2.7 (95% confidence interval, 1.03 to 7.0; P = 0.04) and 2.8 (95% confidence interval, 1.05 to 9.3) for mildly and moderately to severely decreased eGFR, respectively.
Arbitrary definition for residual hypertension.
Two-thirds of patients with aldosterone-producing adenoma were cured of hypertension by means of unilateral adrenalectomy. Kidney function impairment, even mild, appears to be associated with a high incidence of postsurgery residual hypertension.
原发性醛固酮增多症患者醛固酮自主分泌增加肾小球滤过率并导致肾损害。肾功能轻度下降对肾上腺切除术后残余高血压的影响尚不清楚。
非同期前瞻性研究。
该研究基于台湾原发性醛固酮增多症调查（TAIPAI）数据库。1999年7月至2007年1月期间，150例诊断为醛固酮瘤的患者（61例男性；总体平均年龄47.2±11.6岁）在台湾大学医院接受了单侧肾上腺切除术。
术前估计肾小球滤过率（eGFR）。
肾上腺切除术后残余高血压，定义为术后第一年收缩压低于140 mmHg且舒张压低于90 mmHg的血压测量记录中低于75%，或需要使用抗高血压药物。
术前，分别有27例（18%）、72例（48%）和51例（34%）患者的eGFR中度至重度下降（<60 mL/min/1.73 m²）、轻度下降（60≤eGFR<90 mL/min/1.73 m²）或未下降（≥90 mL/min/1.73 m²）。术后，各亚组分别有16例（59.3%）、29例（40.3%）和10例（19.3%）患者出现术后残余高血压。与术前eGFR未下降的患者相比，轻度和中度至重度eGFR下降患者术后残余高血压的校正比值比分别为2.7（95%置信区间，1.03至7.0；P = 0.04）和2.8（95%置信区间，1.05至9.3）。
残余高血压的定义随意。
三分之二的醛固酮瘤患者通过单侧肾上腺切除术治愈高血压。肾功能损害，即使是轻度的，似乎也与术后残余高血压的高发生率相关。
