Discriminating Factors for Recurrent Hypertension in Patients with Primary Aldosteronism after Adrenalectomy

Fukudome, Yuji; Fujii, Koji; Arima, Hisatomi; Ohya, Yusuke; Tsuchihashi, Takuya; Abe, Isao; Fujishima, Masatoshi

doi:10.1291/hypres.25.11

Cited by 35 publications

(36 citation statements)

References 25 publications

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“…At follow-up, all 20 patients who were hypertensive at one month remained hypertensive, and 14 of the 32 patients who were previously normotensive at one month had recurrent hypertension. The rate of recurrent hypertension in our series was 43%, which is compatible with previous reports (Obara et al 1992;Blumenfeld et al 1994;Celen et al 1996;Fukudome et al 2002). Furthermore, we found that pre-operative BP is the only predictor for postoperative hypertension at one month, and pre-operative BP and post-operative plasma aldosterone concentration are the important predictors for hypertension at the long-term follow-up.…”

Section: Discussionsupporting

confidence: 92%

“…Similarly, Lumachi et al (2005) found that the age of patients and duration of hypertension may have a maximum predictive power of 75% for unresolved hypertension. Moreover, Fukudome et al (2002) demonstrated in a multivariate analysis that only pre-operative serum creatinine was independently associated with recurrent hypertension. One of the major differences among these studies is the duration of follow-up period: 6 months in ARS model (Zarnegar et al 2008), 81 months (Lumachi et al 2005), 12.2 years (Fukudome et al 2002), and 51 months in the present study.…”

Section: Discussionmentioning

confidence: 97%

“…Moreover, Fukudome et al (2002) demonstrated in a multivariate analysis that only pre-operative serum creatinine was independently associated with recurrent hypertension. One of the major differences among these studies is the duration of follow-up period: 6 months in ARS model (Zarnegar et al 2008), 81 months (Lumachi et al 2005), 12.2 years (Fukudome et al 2002), and 51 months in the present study. These findings suggest that different factors have variable importance at different follow-up periods.…”

Section: Discussionmentioning

confidence: 97%

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Factors Determining Cardiovascular and Renal Outcomes after Adrenalectomy in Patients with Aldosterone-Producing Adrenal Adenoma

Chiou

Chiang

Fuh

et al. 2009

Tohoku J. Exp. Med.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

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Factors Determining Cardiovascular and Renal Outcomes after Adrenalectomy in Patients with Aldosterone-Producing Adrenal Adenoma

Chiou

Chiang

Fuh

et al. 2009

Tohoku J. Exp. Med.

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“…Numerous factors have been proposed as predictive factors for hypertension recovering, including age at surgery, response to spironolactone, blood pressure levels on discharge (20), duration of hypertension, family history for hypertension, preoperative ratio of plasma aldosterone to PRA (21), renal damage (22), serum potassium levels, sex (23) and vascular remodeling (24).…”

Section: Introductionmentioning

confidence: 99%

Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma

Giacchetti¹,

Ronconi²,

Rilli³

et al. 2009

European Journal of Endocrinology

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Objective: Primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is the most common curable form of secondary hypertension. Design: In order to evaluate blood pressure outcome after adrenalectomy for APA and to identify new favorable prognostic factors, data from 42 consecutive APA patients who underwent adrenalectomy were collected from 2005 to 2007. Methods: Renin-angiotensin-aldosterone system (upright and postsaline infusion test), serum and urinary electrolytes, office and ambulatory blood pressure monitoring were evaluated at baseline and after a follow-up of 2.7G2.2 years. Drug history and adenoma size at morphological evaluation were also collected. Results: Multiple regression analysis showed that, before surgery, patients with a small adenoma (diameter !20 mm) displayed higher postsaline aldosterone values (PZ0.0001), and lower serum potassium levels (PZ0.020), than patients with adenoma O20 mm. Before surgery, mineralocorticoid receptor (MR) antagonists were used in patients with small APA in greater percentage than patients with bigger adenomas (64 vs 30% respectively, PZ0.037). At follow-up, blood pressure normalized in 63% of the subjects. Recovered patients had a shorter duration of hypertension (PZ0.038), and a smaller adenoma size (PZ0.035). Receiver operating characteristic curves showed that a duration of hypertension %6 years and an APA size !20 mm were the best predictors of blood pressure normalization. Patients with APA !20 mm showed the complete restoration of blood pressure circadian rhythm. Conclusions: The presence of APA !20 mm, duration of hypertension equal or less than 6 years, and preoperative MR antagonists use are favorable prognostic factors for hypertension recovery after adrenalectomy.

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“…Several studies showed that BP decreases in the majority of patients but antihypertensive agents are required in a significant proportion of cases in order to achieve a normal BP. Reported rates of BP control vary between 33 and 85% (Table 1), but the definition of normal BP was not uniform in these studies, ranging between 140/90 and 160/100 mmHg (Favia et al 1992, Obara et al 1992, Simon et al 1993, Blumenfeld et al 1994, Weigel et al 1994, Celen et al 1996, Lo et al 1996, Proye et al 1998, Sirén et al 1998, Sapienza & Cavallaro 1999, Shen et al 1999, Brunt et al 2001, Sawka et al 2001, Fukudome et al 2002, Rossi et al 2002, Harris et al 2003, Meria et al 2003, Stowasser et al 2003, Goh et al 2004, Meyer et al 2005, Gockel et al 2007, Pang et al 2007. Table 2 summarizes the criteria used to establish the diagnosis of primary APA in the studies reviewed.…”

Section: Management Of Apamentioning

confidence: 99%

Medical treatment as an alternative to adrenalectomy in patients with aldosterone-producing adenomas

Karagiannis¹,

Τζιόμαλος²,

Kakafika³

et al. 2008

Endocrine Related Cancer

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Primary aldosteronism (PA) and, in particular, its two commonest subtypes (i.e. idiopathic hyperaldosteronism (IHA) and aldosterone-producing adenoma (APA)) have been recognized as the most common cause of secondary hypertension. While 'conservative' medical treatment with aldosterone receptor antagonists is the therapeutic approach of choice in controlling blood pressure in patients with PA due to IHA, the more invasive (laparoscopic) adrenalectomy seems to be the most suitable therapy for patients with APA. In this review, we focus on the medical approach for the management of APA in cases where surgical excision of the adrenal is not possible.

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Discriminating Factors for Recurrent Hypertension in Patients with Primary Aldosteronism after Adrenalectomy

Cited by 35 publications

References 25 publications

Factors Determining Cardiovascular and Renal Outcomes after Adrenalectomy in Patients with Aldosterone-Producing Adrenal Adenoma

Factors Determining Cardiovascular and Renal Outcomes after Adrenalectomy in Patients with Aldosterone-Producing Adrenal Adenoma

Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma

Medical treatment as an alternative to adrenalectomy in patients with aldosterone-producing adenomas

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