Deng Yue, Wang Hanbo, Guo Xudong, Jiang Shaobo, Cai Jun
Hypertension Center of Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Urology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan 271016, Shandong Province, China.
J Transl Int Med. 2021 Jan 5;11(3):275-281. doi: 10.2478/jtim-2023-0107. eCollection 2023 Sep.
Treatment resistant hypertension (trHTN) is a common clinical problem faced by many clinicians. Laparoscopic adrenalectomy effectively trims blood pressure (BP) elevation secondary to various functional adrenal disorders. However, the impact of adrenalectomy on BP within trHTN patients has never been reported. Our present study aims to investigate the effect of adrenalectomy on BP management within trHTN patients, and to explore clinical predictors for postoperative BP normalization.
In our current study, 117 patients diagnosed with trHTN and performed with unilateral adrenalectomy were consecutively enrolled, demographic and medical information were documented for baseline data collection. BP was measured with a standard electronic sphygmomanometer twice a day. Long-term periodical interview was conducted and 109 (93.2%) enrolled patients were successfully followed-up at an averaged 36.2 months.
At follow-up, 27/109 (25%) trHTN patients acquired BP normalization and 68/109 (62%) patients acquired BP improvement. Mean taking anti-hypertensive agents reduced from presurgical 4.24 to present 1.21 ( < 0.01), along with 7.2 mmHg reduction in SBP ( < 0.01). Image macro-adenoma and hypokalemia history were found to be the two strongest predictors for postoperative BP normalization. (= 28.032, < 0.01). The incidence of adverse postoperative events was quite small.
In summary, this current study implicates that adrenalectomy is an efficacious and safe surgical strategy for BP management in trHTN patients. Patients with both unilateral macro-adenoma and hypokalemia are more prone to acquire postoperative BP normalization.
难治性高血压（trHTN）是许多临床医生面临的常见临床问题。腹腔镜肾上腺切除术可有效降低继发于各种功能性肾上腺疾病的血压升高。然而，肾上腺切除术对trHTN患者血压的影响尚未见报道。我们目前的研究旨在探讨肾上腺切除术对trHTN患者血压管理的影响，并探索术后血压正常化的临床预测因素。
在我们目前的研究中，连续纳入了117例诊断为trHTN并接受单侧肾上腺切除术的患者，记录人口统计学和医学信息以收集基线数据。每天用标准电子血压计测量两次血压。进行长期定期随访，109例（93.2%）纳入患者成功随访，平均随访36.2个月。
随访时，27/109（25%）的trHTN患者血压恢复正常，68/109（62%）的患者血压有所改善。平均服用抗高血压药物从术前的4.24种减少到目前的1.21种（<0.01），收缩压降低7.2 mmHg（<0.01）。影像学大腺瘤和低钾血症病史被发现是术后血压正常化的两个最强预测因素（=28.032，<0.01）。术后不良事件的发生率相当低。
总之，本研究表明肾上腺切除术是trHTN患者血压管理的一种有效且安全的手术策略。单侧大腺瘤和低钾血症患者更容易术后血压恢复正常。
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