26 PREDICTORS OF COMPLETE RESOLUTION OF HYPERTENSION AFTER ADRENALECTOMY AMONG JAPANESE PATIENTS WITH ALDOSTERONE-PRODUCING ADENOMA: EXTERNAL VALIDATION OF THE ALDOSTERONOMA RESOLUTION SCORE USING JAPANESE DATA

Abstract

You have accessJournal of UrologyAdrenal: Surgery/Tumors/Benign and Malignant Disease1 Apr 201126 PREDICTORS OF COMPLETE RESOLUTION OF HYPERTENSION AFTER ADRENALECTOMY AMONG JAPANESE PATIENTS WITH ALDOSTERONE-PRODUCING ADENOMA: EXTERNAL VALIDATION OF THE ALDOSTERONOMA RESOLUTION SCORE USING JAPANESE DATA Takanobu Utsumi, Kouji Kawamura, Naoto Kamiya, Takashi Imamoto, Naoki Nihei, Hiroyoshi Suzuki, and Tomohiko Ichikawa Takanobu UtsumiTakanobu Utsumi Chiba, Japan More articles by this author , Kouji KawamuraKouji Kawamura Chiba, Japan More articles by this author , Naoto KamiyaNaoto Kamiya Sakura, Japan More articles by this author , Takashi ImamotoTakashi Imamoto Chiba, Japan More articles by this author , Naoki NiheiNaoki Nihei Chiba, Japan More articles by this author , Hiroyoshi SuzukiHiroyoshi Suzuki Sakura, Japan More articles by this author , and Tomohiko IchikawaTomohiko Ichikawa Chiba, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.088AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Primary aldosteronism due to aldosterone-producing adenoma (APA) is the most common curable cause of secondary hypertension. However, many patients continue to require antihypertensive medications to control their blood pressure after adrenalectomy. Zarnegar et al. developed a prediction model, which was based on the preoperative 4-item aldosteronoma resolution score (ARS), for complete resolution of hypertension after adrenalectomy. The aim of this study was to investigate the preoperative factors predicting complete resolution of hypertension after adrenalectomy and to validate the ARS externally using Japanese data. METHODS Records of 92 Japanese patients who underwent adrenalectomy for APA between June 1997 and April 2010 were reviewed. Patients were distributed in two groups according to whether blood pressure was normal without antihypertensive medications at 6 months postoperatively. Clinical and biochemical data were evaluated at baseline and after the follow-up of 6 months. RESULTS At the end of the follow-up, blood pressure normalized in 43.5% of the patients. Multivariate logistic regression analysis showed that the patients who had complete resolution of hypertension without the need for antihypertensive medications were significantly more likely to have a short duration of hypertension (odds ratio [OR], 5.026; P=0.002), be taking 2 or fewer antihypertensive medications (OR, 3.768; P=0.022), and female (OR, 3.759; P=0.013). Additional factors associated with complete resolution of hypertension based on univariate analysis included younger age, lower body mass index, higher glomerular filtration rate, and no medical history of diabetes mellitus (P<0.05). High ARS (4–5) and low ARS (0–1) with a predictive accuracy of 73.8% and 58.7% respectively were identified among Japanese patients. An ARS of 4 to 5 had a positive predictive value of 67.4% and a sensitivity of 72.5%. An ARS of 0 to 1 had a negative predictive value of 51.5% and a specificity of 88.9%. CONCLUSIONS Complete resolution of hypertension after adrenalectomy for APA is independently associated with a short duration of hypertension, preoperative use of 2 or fewer antihypertensive medications, and female. Moreover, external validation demonstrated that the ARS accurately identified individuals among Japanese population, although it was developed using Western data. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e10 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takanobu Utsumi Chiba, Japan More articles by this author Kouji Kawamura Chiba, Japan More articles by this author Naoto Kamiya Sakura, Japan More articles by this author Takashi Imamoto Chiba, Japan More articles by this author Naoki Nihei Chiba, Japan More articles by this author Hiroyoshi Suzuki Sakura, Japan More articles by this author Tomohiko Ichikawa Chiba, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...