Good blood pressure control on antihypertensives, not only response to spironolactone, predicts improved outcome after adrenalectomy for aldosteronoma.

BACKGROUND: Spironolactone is frequently used before adrenalectomy for hyperaldosteronism to control blood pressure. Response to spironolactone has been suggested to predict a better outcome. However, whether using other antihypertensive medications to control blood pressure predicts outcome remains unknown. We sought to determine the relationship between preoperative normalization of blood pressure with antihypertensive medications and response to adrenalectomy for hyperaldosteronism.
METHOD: A retrospective cohort study of 102 patients who underwent adrenalectomy for hyperaldosteronism at a tertiary medical center were included. Blood pressures were measured at first clinical presentation, preoperatively, postoperatively, and at 1 and 6 months postoperatively. The primary outcome measure was complete resolution of hypertension (blood pressure <140/90) without antihypertensive medications, versus incomplete resolution requiring antihypertensive medications.
RESULTS: Hypertension resolved and medications were discontinued in 39% of patients. Hypertension resolved without medications in 53% of patients who were normotensive preoperatively versus 24% of patients who were hypertensive (P = .006). In contrast, hypertension resolved without medications in only 45% of patients who were normotensive on spironolactone preoperatively versus 34% of patients who were hypertensive (P = .38).
CONCLUSIONS: Patients with good preoperative control of hypertension on antihypertensive medications, irrespective of response to spironolactone, are more likely to have complete resolution.