Vorselaars WMCM, et al. - Via this international cohort study of 435 surgical patients, researchers examined how adrenalectomy influence the blood pressure and need for antihypertensive medications in patients with primary aldosteronism. They identified the achievement of normotension without requiring antihypertensive medications in 27.1% of patients and normotension requiring less than or equal to the number of preoperative antihypertensive medications in 31.0% of patients. These findings suggest adrenalectomy as beneficial for most patients.

• Across 16 referral medical centers in Europe, the United States, Canada, and Australia, researchers conducted a cohort study.
• Inclusion was performed of patients who underwent unilateral adrenalectomy for primary aldosteronism between January 2010 and December 2016.
• From August 2017 to June 2018, data were analyzed.
• They used computed tomography, magnetic resonance imaging, and/or adrenal venous sampling to confirm unilateral disease.
• Exclusion was done of patients who had missing or incomplete preoperative or follow-up data regarding BP or corresponding number of antihypertensive medications.
• Based on postoperative BP and number of antihypertensive medications, they defined the clinical success.
• Normotension without antihypertensive medications define the cure, and normotension with lower or equal use of antihypertensive medications define clear improvement.
• Postoperative normotension with lower antihypertensive use defines the improvement in patients with preoperative normotensivity.
• As the benefits of surgery were less obvious, mainly owing to postoperative, persistent hypertension, all other patients were stratified as no clear success.
• They assessed clinical outcomes at follow-up closest to 6 months after surgery.

• From a cohort of 514 patients who underwent unilateral adrenalectomy, researchers identified a total of 435 patients (84.6%) as eligible on the basis of inclusion and exclusion criteria; 186 (42.3%) of these patients were women; mean (SD) age at the time of surgery was 50.7 (11.4) years.
• One hundred eighteen patients (27.1%) achieved cure, 135 (31.0%) achieved clear improvement, and 182 (41.8%) had no clear success.
• Postoperative hypertension was reported for 166 patients (91.2%) in the subgroup classified as no clear success.
• However, there was a significant decrease in the mean (SD) systolic and diastolic BP by 9 (22) mm Hg (P < .001) and 3 (15) mm Hg (P=.04), respectively within this subgroup
• Also, there was a decrease in the number of antihypertensive medications use from 3 (range, 0-7) to 2 (range, 0-6) (P < .001).
• Moreover, the decrease in systolic BP was 10 mm Hg or greater in 75 of 182 patients (41.2%) within this subgroup.