Wachtel Heather, Cerullo Isadora, Bartlett Edmund K, Kelz Rachel R, Cohen Debbie L, Karakousis Giorgos C, Roses Robert E, Fraker Douglas L
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Surgery. 2014 Dec;156(6):1394-402; discussion1402-3. doi: 10.1016/j.surg.2014.08.021. Epub 2014 Nov 11.
Data on long-term blood pressure (BP) control after adrenalectomy for primary hyperaldosteronism are limited. We analyzed long-term outcomes to identify factors predictive of cure.
We performed a retrospective cohort study of patients undergoing adrenalectomy for primary hyperaldosteronism (1997-2013). BP and antihypertensive medications were assessed at long-term follow-up (≥ 12 months). Primary outcome was cure, defined as normotension off antihypertensives.
Of 85 patients, 15.3% (n = 13) were cured, 54.1% (n = 46) were normotensive while remaining on anti-hypertensives, and 30.6% (n = 26) were hypertensive. Younger age (P = .011), female sex (P < .001), lesser body mass index (P = .018), shorter duration of hypertension (P = .002), lower creatinine (P = .001), and fewer preoperative antihypertensive medications (P < .001) were associated with cure. Female sex, body mass index ≤ 25 kg/m(2), hypertension <5 years, creatinine ≤ 0.8 mg/dL, and <2 antihypertensives were incorporated into a scoring system. For a score of 0-1 (n = 61) the cure rate was 3%; 100% of patients with a score of 4-5 (n = 3) were cured. This scoring system performed comparably to the Aldosterone Resolution Score, which has been used to evaluate short-term postoperative outcomes.
This is the largest study to identify factors associated with long-term BP control after adrenalectomy and incorporate these into a scoring system. These data provide a potential tool to guide preoperative patient counseling.
原发性醛固酮增多症肾上腺切除术后长期血压控制的数据有限。我们分析了长期预后以确定治愈的预测因素。
我们对1997年至2013年因原发性醛固酮增多症接受肾上腺切除术的患者进行了一项回顾性队列研究。在长期随访（≥12个月）时评估血压和抗高血压药物使用情况。主要结局为治愈，定义为停用抗高血压药物后血压正常。
85例患者中，15.3%（n = 13）治愈，54.1%（n = 46）血压正常但仍服用抗高血压药物，30.6%（n = 26）高血压。年龄较小（P = .011）、女性（P < .001）、体重指数较低（P = .018）、高血压病程较短（P = .002）、肌酐水平较低（P = .001）以及术前使用抗高血压药物较少（P < .001）与治愈相关。女性、体重指数≤25 kg/m²、高血压<5年、肌酐≤0.8 mg/dL以及使用<2种抗高血压药物被纳入一个评分系统。对于评分为0 - 1分的患者（n = 61），治愈率为3%；评分为4 - 5分的患者（n = 3）全部治愈。该评分系统的表现与用于评估术后短期结局的醛固酮缓解评分相当。
这是确定肾上腺切除术后长期血压控制相关因素并将其纳入评分系统的最大规模研究。这些数据提供了一个潜在工具来指导术前患者咨询。
