Abstract P117: Blood Pressure Outcomes in Patients With Primary Aldosteronism after Adrenalectomy versus Medical Management in Relation to the New 2017 ACC/AHA Blood Pressure Guidelines

Abstract

Objective: Investigate blood pressure (BP) outcomes in primary aldosteronism (PA) patients following adrenalectomy or medical therapy in the context of the lower BP target goal and threshold proposed by the 2017 ACC/AHA blood pressure guidelines. Methods: A retrospective study was conducted in patients with confirmed diagnosis of PA who were referred to Hypertension clinic at the University of Texas Southwestern between January 2009 and August 2017. Presence of PA was confirmed using previously recommended cutoff values of urinary aldosterone greater than 12 mcg/2h for the oral salt loading test and serum aldosterone greater than 10 ng/dL after intravenous saline suppression test. Patients were categorized into adrenalectomy or medical therapy groups. The average BP and number of anti-hypertensives were compared between the two groups at each clinic visit. Hypertension cure rate of PA patients undergoing adrenalectomy was compared using the JNC8 threshold BP of 140/90 mmHg versus the 2017 ACC/AHA threshold BP of 130/80 mmHg. Results: Forty-nine patients were found to have PA. Twenty-two patients had an adrenalectomy, twenty-seven patients were started on a mineralocorticoid antagonist. The adrenalectomy subgroup required a fewer number of anti-hypertensives at the last follow-up visit (p=0.0004) compared to the medically treated group. Systolic BP reduced similarly from the baseline visit to the last visit in the adrenalectomy group compared to the medical therapy group (from 151.3 +/- 5.7 to 134.3 +/- 4.5 mmHg vs. 149 +/- 4.1 to 134.7 +/- 4.1 mmHg, p < 0.01 for visit and p=0.5 for group). Thirteen percent (3 of 23) of adrenalectomy patients achieved cure based on the previous JNC8 guidelines, whereas only 8.7% (2 of 23) achieved cure based on the current guidelines. Conclusion: Adrenalectomy is more efficacious than medical management in reducing the number of anti-hypertensives needed for BP control. The percentage of patients who achieved cure following adrenalectomy decreased when defined by the 2017 ACC/AHA guidelines.