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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (4): 686-691. doi: 10.19723/j.issn.1671-167X.2022.04.017

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Risk factors of persistent hypertension in primary aldosteronism patients after surgery

Yu-chao HUANG-FU,Yi-qing DU,Lu-ping YU,Tao XU*()   

  1. Department of Urology, Peking University People' s Hospital, Beijing 100044, China
  • Received:2022-03-31 Online:2022-08-18 Published:2022-08-11
  • Contact: Tao XU E-mail:xutao@pkuph.edu.cn

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Abstract:

Objective: To analyze the risk factors of persistent hypertension in patients who underwent adrenalectomy for primary aldosteronism and to evaluate the predictive value of the aldosteronoma resolution score (ARS) scoring system for surgical outcomes of adrenalectomy for primary aldosteronism. Methods: We reviewed the clinical characteristics of patients who underwent adrenalectomy for primary aldosteronism from 2018 to 2021 at Peking University People' s Hospital to recognize risk factors of uncured hypertension after surgery. Based on the patient' s clinical outcomes, the patients were divided into complete success group and partial/absent success group. Risk factors for persistent hypertension were analyzed. The value of the ARS scoring system was assessed by the area under the curve (AUC). Results: In this study, 112 patients were included. Most of the patients benefited from the surgery for 94.6% were a complete or partial clinical success after follow-up for at least 6 months. According to postoperative hypertension status, the patients were divided into complete success group (51 cases) and partial/absent success group (61 cases). There were statistical differences between the two groups in age, body mass index (BMI), waist circumference, duration of hypertension, number of preoperative antihypertension medications, preoperative systolic blood pressure, history of diabetes, history of cardiovascular and cerebrovascular diseases, serum creatinine, estimated glomerular filtration rate(eGFR), high-density lipoprotein cholesterol and triglyceride. Logistic regression analysis showed that age (OR=1.111, 95%CI: 1.029-1.199), waist circumference (OR=1.073, 95%CI: 1.013-1.137), pre-operative systolic blood pressure (OR=1.033, 95%CI: 1.008-1.060) and history of cardiovascular and cerebrovascular diseases (OR=16.061, 95%CI: 1.312-196.612) were the risk factors for uncured hypertension in primary aldosteronism patients after surgery, but female gender not. The median ARS in the complete success group was 4 and in the partial/absent success group, it was 2. Among the patients with ARS of 4-5, the cure rate of hypertension was 76.5%. The area under the curve of ARS was 0.743. Conclusion: The history of cardiovascular and cerebrovascular diseases is a significant risk factor for persistent hypertension after surgery in primary aldosteronism patients. ARS scoring system has a certain value in predicting the postoperative hypertension status of primary aldosteronism patients. However, further research is still needed on a prediction model for surgical outcomes of primary aldosteronism which is more suitable for the Chinese population is still needed.

Key words: Primary aldosteronism, Adrenalectomy, Hypertension

CLC Number: 

  • R699

Table 1

Clinical characteristics of study patients"

Items Complete success(n=51) Partial/absent success(n=61) P
Femal，n(%) 26 (51.0) 21 (34.4) 0.087
Age/years，$\bar x \pm s$ 40.6±8.6 50.9±9.8 ＜0.001
BMI/(kg/m2)，$\bar x \pm s$ 25.0±3.6 27.2±4.0 0.002
Waist circumference/cm，$\bar x \pm s$ 86.6±11.2 95.22±10.1 ＜0.001
Duration of hypertension/months，M(P25, P75) 36 (12, 60) 120 (60, 240) ＜0.001
Number of preoperative antihypertensive medications，M(P25, P75) 2 (1, 3) 3 (2, 3) 0.001
SBP/mmHg，M(P25, P75) 170 (155, 180) 180 (170, 210) ＜0.001
DBP/mmHg，M(P25, P75) 102 (100, 120) 110 (92, 120) 0.391
History of preoperative hypokalemia，n(%) 43 (84.3) 48 (78.7) 0.477
Diabetes mellitus，n(%) 3 (5.9) 14 (23.0) 0.016
Cardiovascular or cerebrovascular disease，n(%) 1 (2.0) 22 (36.1) ＜0.001
Lowest serum potassium concentration on record/(mmol/L)，M(P25, P75) 2.8 (2.4, 3.2) 3.0 (2.5, 3.1) 0.638
Serum K+/(mmol/L)，M(P25, P75) 4.0 (3.7, 4.3) 4.1 (3.6, 4.4) 0.250
Serum Na+ /(mmol/L)，M(P25, P75) 140.4 (138.8, 142.0) 140.0 (138.6, 141.0) 0.222
Serum creatine/(μmol/L)，M(P25, P75) 72.0 (60.0, 84.0) 82.0 (71.0, 95.5) 0.004
eGFR[mL/(min·1.73 m2)]，M(P25, P75) 102.9 (91.7, 111.0) 88.5 (71.4, 102.0) ＜0.001
HDL-C /(mmol/L)，M(P25, P75) 1.11 (0.99, 1.46) 0.99 (0.89, 1.16) 0.011
TG /(mmol/L)，M(P25, P75) 1.07 (0.83, 1.60) 1.43 (0.88, 2.11) 0.045
Cortisol(8：00)/(μg/dL)，M(P25, P75) 10.4 (8.6, 12.4) 10.8 (8.9, 13.4) 0.471
DRC/(mIU/L)，M(P25, P75) 1.5 (0.8, 3.4) 2.2 (1.0, 6.1) 0.226
PAC/(ng/dL)，M(P25, P75) 37.4 (21.0, 47.6) 35.7 (23.4, 54.7) 0.474
ARR/[(ng/dL)/(mU/L)]，M(P25, P75) 17.7 (8.4, 54.8) 14.5 (6.6, 36.0) 0.478

Table 2

Univariate and multivariate Logistic regression analysis"

Variable Univariate Multivariate
Crude OR(95%CI) P Adjusted OR(95%CI) P
Age 1.123 (1.069-1.180) ＜0.001 1.111 (1.029-1.199) 0.007
Female 0.505 (0.236-1.081) 0.079
BMI 1.174 (1.054-1.308) 0.004
Waist circumference 1.081 (1.037-1.126) ＜0.001 1.073 (1.013-1.137) 0.017
Duration of hypertension 1.017 (1.009-1.025) ＜0.001
Number of preoperative antihypertensive medications 1.870 (1.237-2.828) 0.003
SBP 1.035 (1.016-1.054) ＜0.001 1.033 (1.008-1.060) 0.010
Diabetes mellitus(Yes) 4.766 (1.286-17.667) 0.019
Cardiovascular or cerebrovascular disease(Yes) 28.205 (3.641-218.502) 0.001 16.061 (1.312-196.612) 0.030
Serum creatine 1.028 (1.007-1.049) 0.009
eGFR 0.961 (0.940-0.982) ＜0.001
HDL-C 0.152 (0.035-0.667) 0.013
TG 1.450 (0.857-2.452) 0.166

Table 3

Results of ARS of study patients"

ARS Complete success (n=51) Partial/absent success (n=61) Cure rates/%
0-1 9 23 28.1
2-3 16 30 34.8
4-5 26 8 76.5

Figure 1

ROC curve of aldosteronoma resolution score (ARS)"

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