The underlying cause of resistant
hypertension after
adrenalectomy for
primary hyperaldosteronism remains controversial. The objective of this study was to identify preoperative factors predictive of resistant
hypertension in patients after undergoing retroperitoneoscopic
adrenalectomy. Between 2003 and 2009, 124 patients with unilateral
aldosterone-producing
adenoma or unilateral adrenal
hyperplasia underwent retroperitoneoscopic
adrenalectomy at our institution. Clinical and biochemical data were reviewed retrospectively at baseline and after a median follow-up time of 59.2 ± 37.2 months.
Adrenalectomy cured
hypertension in 68 patients (54.8%) and 43 (34.8%) had persistent
hypertension that was much easier to control after surgery, whereas 13 patients (10.4%) had continued
hypertension and poor blood pressure control. Multivariate regression analysis revealed that the main determinants of postoperative cure were duration of
hypertension less than 5 years [odds ratio (OR): 6.515, 95% confidence interval (CI) 2.278-10.293), number of
antihypertensive medications ≤2 (OR: 2.939, 95% CI 1.254-5.235), preoperative response to
spironolactone (OR: 3.405, 95% CI 1.681-6.985), the TT genotype of the
CYP11B2 gene (344 C/T) (OR: 2.765, 95% CI 1.221-4.986), and the presence of
adenoma rather than
hyperplasia (OR: 5.274, 95% CI 2.150-8.141). The main determinants of surgical cure or control of
hypertension in patients with
primary hyperaldosteronism were duration of
hypertension, number of
antihypertensive medications, preoperative response to
spironolactone, the presence of
adenoma, and
CYP11B2 (344 C/T) genotype. Consideration of these factors may help in the evaluation of patients for surgery and for the identification of patients with continued postoperative
hypertension that may require more long-term monitoring and treatment.