PP.25.08] IS ARTERIAL STIFFNESS EVALUATED BY PULSE WAVE VELOCITY PREDICTIVE OF THE IMPROVEMENT OF HYPERTENSION AFTER ADRENAL SURGERY FOR PRIMARY ALDOSTERONISM?

Abstract

Objective: Predictive factors associated with normal blood pressure (BP) values after unilateral adrenalectomy for primary aldosteronism are not clearly identified. Arterial stiffness could play a role in the persistence of hypertension. The aim was to evaluate the predictive value of arterial stiffness assessed before surgery on BP after surgery. Design and method: From 2009–2013, in a French multicentre open-labelled prospective study, 96 patients with primary aldosteronism due to unilateral adrenal adenoma with an indication for surgery were recruited (age 48 ± 12; 47.6% of women; SBP/DBP: 150 ± 21/91 ± 15 mmHg; kalemia: 3.4 ± 0.5). Plasma aldosterone concentration (PAC) was conventionally measured (Normal values: 40–175 ng/l), either direct renin concentration (DRC) (4.2–59.7 mU/l) or plasma renin activity (PRA) (>0.4 ng/ml/h). Aortic pulse wave velocity (PWV) was assessed before surgery (Complior ®) They underwent an ABPM before and 3 to 6 months after surgery (Spacelab's ®) Normal BP values were defined as mean 24-hour-SBP/DBP<130/80 mmHg between 3 to 6 months after adrenalectomy Results: BP and PWV were available for 82 patients. At baseline, mean PAC was 368 ± 244 pg/ml, DRC was 4.4 ± 4.2 mU/L (n = 58) and PRA was 0.19 ± 0.18 ng/ml/h. Six months after surgery, office SBP/DBP was 131/81 mmHg. Mean 24-hour-SBP/DBP decreased (from 144 ± 15/91 ± 9 before to 131 ± 15/84 ± 11 mmHg). 40 of them who underwent ABPM at 12 months had 24-hour-SBP/DBP 125 ± 15/81 ± 9 mmHg. No patient needed potassium supplementation after surgery (vs 56% before). 64.7% of women and 35.3% of men had 24h-SBP/DBP<130/80 mmHg at 6 months (p = 0.07) and 68.8% vs 31.3% at 12 months (n = 40) (p = 0.03). SBP/DBP was higher for men than for women after 6 months (p = 0.01/0.001) and 1 year (p = 0.04/0.05). Mean PWV was 10.5 ± 3.6 m/s among patients with mean 24h-SBP/DBP<130/80mmHg vs 10.3 ± 2.3 m/s for patients with 24h-SBP/DBP>130/80mmHg (p = 0.96). 52.9% of patients with PWV<10m/s (median value) and 47.1% of patients with PWV values>10 m/s had 24h-SBP/DBP<130/80 mmHg (p = 0.91). No significant association between initial PWV and SBP or DBP after surgery was found. Conclusions: In our multicentre study, arterial stiffness reflected by PWV measured pre-operatively does not predict a benefit of adrenalectomy on blood pressure values. More women than men had normal BP values after surgery.