Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
Ann Surg. 2022 Nov 1;276(5):929-934. doi: 10.1097/SLA.0000000000005639. Epub 2022 Jul 27.
We aimed to investigate the postoperative trend in blood pressure (BP)-related outcomes [BP and antihypertensive (AHT) drug use] during the year following adrenalectomy for primary aldosteronism (PA) to determine the optimal timing for outcome assessment and to determine the necessary follow-up length.
Since the course of BP-related outcomes after adrenalectomy is unknown, the optimal timing of outcome assessment and follow-up duration are not clear.
In this retrospective single center cohort study, we used a prospectively collected database with all patients referred for difficult-to-control-hypertension-analysis. All patients diagnosed with PA who underwent adrenalectomy were included. AHT drug use [in defined daily dose (DDD)] and home blood pressure measurements (HBPMs) during the first postoperative year were collected. A mixed-effects model was developed to assess the stability of DDD and HBPM over time and adjust for potential confounders.
In total 1784 patients were assessed for difficult-to-control-hypertension of whom 41 were included. Both the DDD and HBPM showed the strongest decrease in the first postoperative month (mean 1.6DDD; mean 140/85 mm Hg) compared with preoperative values (4.5DDD; 153/92 mm Hg). Thereafter, both outcomes showed a stable course from 4 to 6 months (1.6DDD; 136/86 mm Hg) up to 12 months postoperatively (2.0DDD; 136/83 mm Hg).
This study showed that AHT drug use and HBPM decreased substantially within the first month after adrenalectomy for PA and afterwards generally remained stable during the year following adrenalectomy. We propose that BP-related outcomes can be assessed reliably early after adrenalectomy and question the need for routine long-term follow-up in referral centers.
本研究旨在调查原发性醛固酮增多症（PA）患者术后 1 年内与血压（BP）相关的结局（BP 和抗高血压药物（AHT）使用情况）的变化趋势，以确定评估结局的最佳时间，并确定必要的随访时间长度。
由于术后 BP 相关结局的变化过程尚不清楚，因此，评估结局的最佳时间和随访时间长度尚不清楚。
本回顾性单中心队列研究使用了一个前瞻性收集的数据库，其中包含所有因难治性高血压而就诊的患者。所有接受肾上腺切除术的 PA 患者均被纳入研究。收集了患者术后 1 年内 AHT 药物使用（以限定日剂量（DDD）表示）和家庭血压测量（HBPM）数据。建立了混合效应模型来评估 DDD 和 HBPM 随时间的稳定性，并调整潜在混杂因素。
共有 1784 例患者被评估为难治性高血压，其中 41 例被纳入研究。与术前相比，DDD（平均 1.6DDD）和 HBPM（平均 140/85mmHg）在术后第 1 个月下降最明显（DDD 为 4.5DDD，HBPM 为 153/92mmHg）。此后，从术后 4 个月到 6 个月（DDD 为 1.6DDD，HBPM 为 136/86mmHg），再到术后 12 个月（DDD 为 2.0DDD，HBPM 为 136/83mmHg），这两个结局都保持稳定。
本研究表明，PA 患者肾上腺切除术后 AHT 药物使用和 HBPM 显著降低，术后 1 年内基本保持稳定。我们提出，术后早期可以可靠地评估 BP 相关结局，质疑在转诊中心是否需要常规进行长期随访。
