Effectiveness of Unilateral Adrenalectomy in Primary Hyperaldosteronism on Blood Pressure Regulation

Purpose: The study was designed to determine the long-term outcome of the blood pressure after surgical treatment in primary hyperaldosteronism. Methods: The medical records of patients with unilateral primary hyperaldosteronism who had undergone laparoscopic adrenalectomy were retrospectively reviewed from January 2001 to December 2020 in a single center. Patient demographics, postoperative blood pressure changes and related factors of clinical success in patients with primary hyperaldosteronism were analyzed. Results: Of 63 patients enrolled and analyzed, 32 (51%) achieved complete clinical success, 31 (49%) achieved partial clinical success, and 0 (0%) had no clear success. However, within the partial clinical success group, the mean±standard deviation systolic and diastolic BP decreased significantly by 23.3±28.5 mmHg (P<0.01) and 6.5±18.9 mmHg (P=0.06), respectively. Also, the number of antihypertensive medications used decreased from 6 (range, 3-16) to 2 (range, 0.5-6.5) (P<0.01). In univariate analysis, being male (P<0.01), the number of preoperative anti-hypertensive drugs administered (P<0.01), and the preoperative systolic blood pressure (P=0.01) were the main factors related to partial clinical success after adrenalectomy. In multivariate regression analysis, uncured hypertension was independently associated with the number of preoperative antihypertensive agents (P=0.04) Conclusion: Although hypertension cannot be cured in all patients, unilateral adrenalectomy performed for localized primary hyperaldosteronism is effective in improving hypertension in patients with primary hyperaldosteronism.