Arterial stiffness evaluated by pulse wave velocity is not predictive of the improvement in hypertension after adrenal surgery for primary aldosteronism: A multicentre study from the French European Society of Hypertension Excellence Centres

Arch Cardiovasc Dis. 2018 Oct;111(10):564-572. doi: 10.1016/j.acvd.2018.01.004. Epub 2018 Mar 16.

Abstract

Background: Predictive factors associated with normal blood pressure (BP) after unilateral adrenalectomy for primary aldosteronism (PA) are not clearly identified.

Aims: To evaluate the predictive value of arterial stiffness before surgery on BP after surgery.

Methods: During 2009-2013, 96 patients with PA due to unilateral adrenal adenoma who underwent surgery were enrolled in a multicentre open-label, prospective study. Aortic pulse wave velocity (PWV) was assessed before surgery. Patients underwent ambulatory blood pressure monitoring (ABPM) before surgery and 6 and 12months after surgery. Twenty-four h SBP/DBP values were compared in subjects with PWV<vs. ≥10m/s. The primary outcome was 24-hour ABPM<130/80mmHg 6 months after adrenalectomy.

Results: BP and PWV were available for 82 patients (mean age 49±12years). Mean 24-hour systolic/diastolic BP (SBP/DBP) values decreased from 144±15/91±9 before surgery to 131±15/84±11mmHg 6months after surgery. At 6months, mean 24-hour SBP did not differ significantly between high versus low PWV groups (SBP-0.8mmHg, 95% confidence interval-6.9 to 5.2, P=0.79). A total of 42.3% of women versus 20.0% of men had 24-hour SBP/DBP<130/80mmHg at 6months (P=0.07) and 57.9% vs. 23.8% at 12months (P=0.03). Higher SBP/DBP was recorded for men versus women after 6months (P=0.01/0.001) and 1year (P=0.04/0.05).

Conclusion: Preoperative arterial stiffness does not predict a beneficial effect of adrenalectomy on BP values.

Keywords: Hyperaldostéronisme primaire; Primary aldosteronism; Pulse wave velocity; Vitesse de l’onde de pouls.

Publication types

  • Multicenter Study

MeSH terms

  • Adrenal Cortex Neoplasms / complications
  • Adrenal Cortex Neoplasms / diagnosis
  • Adrenal Cortex Neoplasms / physiopathology
  • Adrenal Cortex Neoplasms / surgery*
  • Adrenalectomy*
  • Adrenocortical Adenoma / complications
  • Adrenocortical Adenoma / diagnosis
  • Adrenocortical Adenoma / physiopathology
  • Adrenocortical Adenoma / surgery*
  • Adult
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Area Under Curve
  • Blood Pressure Monitoring, Ambulatory
  • Blood Pressure* / drug effects
  • Female
  • France
  • Humans
  • Hyperaldosteronism / diagnosis
  • Hyperaldosteronism / etiology
  • Hyperaldosteronism / physiopathology
  • Hyperaldosteronism / surgery*
  • Hypertension / diagnosis*
  • Hypertension / drug therapy
  • Hypertension / etiology
  • Hypertension / physiopathology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Pulse Wave Analysis*
  • ROC Curve
  • Reproducibility of Results
  • Time Factors
  • Treatment Outcome
  • Vascular Stiffness*
  • Young Adult

Substances

  • Antihypertensive Agents