Clinical presentation and surgical outcomes in primary aldosteronism differ by race

Abstract

Background: Primary aldosteronism (PA) is the most common cause of secondary hypertension; early diagnosis and intervention correlate with outcomes. We hypothesized that race may influence clinical presentation and outcomes.Methods: We conducted a retrospective analysis of patients with PA (1997PA ( -2017 who underwent adrenal vein sampling (AVS). Patients were classified by self-reported race as black or non-black. Improvement was defined as postoperative decrease in mean arterial pressure (MAP), antihypertensive medications (AHM), or both.Results: Among patients undergoing AVS (n = 443), 287 underwent adrenalectomy. Black patients (28.2%) had higher body mass index (33.9 vs 31.8 kg/m 2 ; P = .01), longer median duration of hypertension (12 vs 10 years; P = .003), higher modified Elixhauser comorbidity index (2 vs 1; P = .004), and lower median income ($47 134 vs $78 280; P < .001). Black patients had similar aldosterone:renin ratios (150 vs 135.6 [ng/dL]/[ng·mL· −1 hr −1 ]; P = .23) compared to non-blacks. At long-term follow-up, black patients had a similar requirement for AHM (1 vs 0; P = .13) but higher MAP (100.6 vs 95.3 mm Hg; P = .004).Conclusion: Black patients present with longer duration of hypertension and more comorbidities. They are equally likely to lateralize on AVS, suggesting similar disease phenotype. However, black patients demonstrate less improvement with adrenalectomy; this may reflect a delay in diagnosis or concomitant essential hypertension.adrenal, aldosteronoma, disparities, hypertension, primary aldosteronism, race 1 | INTRODUCTION Primary aldosteronism (PA) is the most common etiology of secondary hypertension, affecting 3% to 20% of hypertensive patients 1-4 and 14%to 21% of patients with resistant hypertension. 5 Hyperaldosteronism is associated with end organ dysfunction and cardiovascular morbidity and mortality, independent of level of hypertension. 6-8 As compared to those with essential hypertension, patients with PA have increased risk of myocardial infarction, atrial fibrillation, and stroke, in excess of the projected risk related to degree of hypertension alone. 9 Effective control of blood pressure (BP) and aldosterone level lead to improved cardiovascular outcomes. 10 Therefore, early diagnosis and appropriate treatment of PA is essential to improve cardiovascular outcomes and minimize end organ dysfunction. Subtype differentiation of PA is an essential component of early diagnosis and treatment. Unilateral causes of PA include aldosteroneproducing adenoma and unilateral hyperplasia, which are potentially The authors have no disclosures.surgically curable, while bilateral adrenal hyperplasia (BAH) is managed medically with mineralocorticoid antagonists. 11 Shorter duration of disease has been associated with improved operative outcomes in multiple studies of subjects with unilateral PA. 12,13 An extensive literature exists on race and hypertension, particularly as it pertains to black patients. 14,15 Racial disparities in diagnosis, prevalence, treatment, and outcomes, a...

Outcomes of Adrenalectomy and the Aldosteronoma Resolution Score in the Black and Hispanic Population

“…The outcomes we present after adrenalectomy for PA are similar to other populations previously published [4]- [9,13].…”

“…The median age and BMI were 43 years (18-73) and 27 kg/m 2 (20-46), respectively. The median duration of HTN was 2.3 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Median preoperative systolic and diastolic BP was 150 mmHg (110-249) and 98 mmHg (70-151) on 3 (1-8) antihypertensives.…”

“…These cohorts have a higher prevalence of essential HTN as well as non‐adrenal‐related secondary HTN compared to other races. This variation is often attributed to genetic and socioeconomic differences in these groups [11, 13]. Therefore, there may be a clinical success disparity in these populations treated with adrenalectomy for PA. Clinical success following adrenalectomy for PA in the Black and Hispanic population remains unclear.…”

Predictive model of hypertension resolution after adrenalectomy in primary aldosteronism: the SPAIN-ALDO score

“…This finding could be related to the fact there are differences in the clinical presentation of PA according to race. For example, black patients present with a longer duration of hypertension and more comorbidities than nonblack [27], so worse surgical outcomes may be expected in this population. Based on the comparison of the ROC curve of the different models in the Spanish population, we found that the best models to predict hypertension cure in this population are the SPAIN-ALDO score and Burello's model.…”

Corrigendum

“…In the article by Gershuni et al, 1 the text of the acknowledgement section has to be amended so that it reflects that the article is NIH funded. This article was published in Journal of Surgical Oncology in March 2020 (https://doi.org/10.1002/jso.25806).…”