Long-term blood pressure control in patients undergoing adrenalectomy for primary hyperaldosteronism

Role of adrenal vein sampling in primary aldosteronism: Impact of imaging, localization, and age

“…These patients represent an opportunity to improve care since based upon imaging results they may incorrectly be classified as hyperplasia and not referred for further work up, and therefore denied a potentially curative procedure. Failure of early identification of surgically amenable PA places these patients at greater risk of irreversible renal and cardiovascular dysfunction, as longer duration of hypertension is a known risk factor for persistent hypertension following adrenalectomy .…”

Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney

“…However, because PA is common among the hypertensive population, possibly accounting for as many as 5-13% of patients, an argument can be made for considering the diagnosis in all hypertensives (205,491). The degree of benefit achieved from specific treatment of PA (and especially the chance of cure of hypertension following unilateral adrenalectomy for unilateral forms of PA) has repeatedly been shown to be inversely related to the preexisting duration of hypertension (95,189,300,548,590,592), arguing for early diagnosis rather than waiting until hypertension becomes severe and resistant. Furthermore, screening patients before they are commenced on antihypertensive medications has the added advantage of avoiding potentially confounding effects of treatment on plasma renin and aldosterone levels which could lead to false-positive or -negative screening results.…”

Is it time to screen all patients with hypertension for primary aldosteronism?

“…6 Targeted treatment of PA using surgery or mineralocorticoid receptor antagonists, such as spironolactone and eplerenone, rather than non-specific antihypertensive medications, can reverse the underlying cardiovascular pathology. 14 Studies have repeatedly shown that treatment outcomes are better in younger patients with a shorter duration of disease, [15][16][17] highlighting the importance of diagnosing the disease early rather than waiting for the development of severe or resistant hypertension with associated end-organ damage. Furthermore, the accurate diagnosis of a unilateral aldosterone-producing adrenal adenoma permits surgical resection which, when compared with medical therapy, offers a faster onset of BP normalisation, earlier reduction of left ventricular mass, reduced medication use, reduced clinical visits, improved anxiety and depression as well as improved quality of life.…”