Harirugsakul Kawintharat, Suharitdumrong Swiss, Panumatrassamee Kamol, Ratchanon Supoj, Usawachintachit Manint, Sowanthip Dutsadee, Pobpan Pea, Sainont Gantapong, Santingamkun Apirak
Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
Sci Rep. 2025 May 29;15(1):18935. doi: 10.1038/s41598-025-03912-w.
Primary aldosteronism (PA) is the most common endocrinologic hypertension, affecting 3.9-15% of hypertensive patients. While unilateral PA is potentially curable through adrenalectomy, a significant proportion of patients experience persistent hypertension despite successful surgery. This study developed and validated a novel predictive scoring model for persistent hypertension following adrenalectomy based on 363 patients from a 25-year single-center experience. Persistent hypertension occurred in 59.5% of patients postoperatively. Multivariable analysis identified five independent predictors: age ≥ 50 years, dyslipidemia, BMI ≥ 25 kg/m, use of ≥ 3 antihypertensive medications, and hypertension duration ≥ 5 years. The model demonstrated excellent discriminative ability with area under the curve of 0.81 in internal validation and 0.72 in external validation. Predictive risk scores were categorized into low-risk (0-1), intermediate-risk (2-3), and high-risk (4-5) groups, with persistent hypertension rates of 23.5%, 72.1%, and 90.6%, respectively. This practical scoring system enables improved preoperative counseling and individualized management planning using readily available clinical parameters.
原发性醛固酮增多症（PA）是最常见的内分泌性高血压，影响3.9%至15%的高血压患者。虽然单侧PA可通过肾上腺切除术治愈，但相当一部分患者尽管手术成功仍会持续高血压。本研究基于25年单中心经验的363例患者，开发并验证了一种用于肾上腺切除术后持续性高血压的新型预测评分模型。术后59.5%的患者出现持续性高血压。多变量分析确定了五个独立预测因素：年龄≥50岁、血脂异常、BMI≥25kg/m²、使用≥3种抗高血压药物以及高血压病程≥5年。该模型在内部验证中的曲线下面积为0.81，在外部验证中的曲线下面积为0.72，显示出优异的判别能力。预测风险评分分为低风险（0 - 1）、中度风险（2 - 3）和高风险（4 - 5）组，持续性高血压发生率分别为23.5%、72.1%和90.6%。这种实用的评分系统能够利用现成的临床参数改善术前咨询和个性化管理规划。
