PROSPECTIVE OBSERVATIONAL STUDY ASSESSING AMBULATORY BLOOD PRESSURE IN PRIMARY ALDOSTERONISM AFTER SURGICAL AND MEDICAL TREATMENT

Abstract

Objective: Primary aldosteronism (PA) affects 5–10% of all patients with hypertension. Patients with PA can be treated with mineralocorticoid antagonists (medications), or curative adrenalectomy (surgery) if they have unilateral PA. Some studies have shown that surgery leads to greater improvement in blood pressure (BP) compared with medications. Design and method: We conducted a prospective study from 2016 - 2019 in patients with PA to assess for BP changes after both surgical and medical treatment. All patients had a 24hr ambulatory BP measurement done before treatment, and 12 months after. Daytime ambulatory systolic BP, diastolic BP, number of hypertension medications, and WHO defined daily dose (DDD) of hypertension medications were compared at baseline versus 12 months post-treatment. Results: 32 patients with PA, mean age 56.0 ± 10.5 yr, 7 females (21.9%) completed both baseline and 12 months post-treatment ambulatory blood pressure. 13 patients (40.6%) were treated with surgery, and the remaining 19 patients were treated with medications. In the entire cohort, daytime systolic BP improved from 144.0 to 135.8 mmHg, P < 0.05, and diastolic BP from 87.3 to 84.8 mmHg, P = 0.18. In patients post-surgery, there was a trend towards improvement in systolic BP from 148.8 to 137.6 mmHg, P = 0.13, and diastolic BP from 92.1 to 85.7 mmHg, P = 0.09. In addition, there was a significant decrease in use of hypertension medications, from 2.1 to 0.7 medications, P < 0.01, and DDD from 3.6 to 0.8, P < 0.01. In patients post-medical treatment, systolic BP improved from 140.8 to 134.5, P = 0.035, diastolic BP did not change from 84.1 to 84.2, P = 0.93. There was an increase in number of hypertension medications from 1.9 to 2.7, P < 0.01, and DDD from 3.1 to 3.5, P = 0.24. Conclusions: Treatment of PA leads to improvement of blood pressure. In patients with unilateral PA who undergo surgery, this is also accompanied with a significant reduction in use of antihypertensive medications.