Predictive model of hypertension resolution after adrenalectomy in primary aldosteronism: the SPAIN-ALDO score

Abstract

Purpose: To develop a predictive model of hypertension resolution after adrenalectomy in patients with primary aldosteronism (PA), based on their presurgical characteristics.Methods: A retrospective multicenter study of PA patients in follow-up in 20 Spanish tertiary hospitals between 2018 and 2021 was performed (SPAIN-ALDO Register). Clinical response postadrenalectomy was classified according to the primary aldosteronism surgical outcome (PASO) consensus criteria. The predictive model was developed using a multivariate logistic regression model with the estimation of all possible equations.Results: A total of 146 patients (54.8% females; mean age of 51.5 AE 10.9 years) with PA who underwent unilateral adrenalectomy were included. After a mean follow-up of 29.1 AE 30.43 months after surgery, hypertension cure was obtained in 37.7% (n ¼ 55) of the patients. The predictive model with the highest diagnostic accuracy to predict hypertension cure combined the variables female sex, use of two or fewer antihypertensive medications, hypertension grade 1, without type 2 diabetes and nonobesity. The area under the receiver operating characteristic curve of this model was 0.841 [0.769-0.914]. Based on this model, the group of patients with a higher probability of cure (80.4%) were those without type 2 diabetes, BMI <30 kg/m 2 , female sex, hypertension grade 1 and who use two or fewer antihypertensives. Our predictive model offered a slightly higher diagnostic accuracy than Wachtel's (area under the curve [AUC]: 0.809), Utsumi's (AUC: 0.804) and Zarnegar's (AUC: 0.796) models and was similar than the Burello's (AUC: 0.833) model. Conclusion:Female sex, use of two or fewer antihypertensive medications, hypertension grade 1, no type 2 diabetes and nonobesity may predict hypertension cure after adrenalectomy in patients with PA. Our score provides a potential tool to guide preoperative patient counseling.

Pitfalls in the preoperative and postoperative workup of patients with primary aldosteronism

“…At the last follow-up, it was achieved in 31% of patients in the series of Vignaud ( 1 ). These results are in accordance with the reported in our Spanish registry, of 38% ( 14 ). Nevertheless, it should be noted that even biochemical cure without hypertension cure is associated with an improvement in the cardiometabolic risk and a major increase in health-related quality of life (HRQoL) after surgery.…”

“…In agreement with the results of the Eurocrine Study Group ( 1 ), the SPAIN-ALDO score includes female sex, use of two or fewer antihypertensive medications, hypertension grade 1, no type 2 diabetes and non-obesity as the predictive variables of hypertension cure. The chance of hypertension cure was 80.4% if all these variables were present before surgery ( 14 ). Nevertheless, in the Vignaud et al ( 1 ) study, body mass index, duration of hypertension, and number of antihypertensive drugs were the important predictive variables of hypertension cure identified on the multivariate analysis.…”

Laparoscopic adrenalectomy for adrenal tumors with endocrine activity: Perioperative management pathways for reduced complications and improved outcomes

“…38 Some researchers developed predictive models for postoperative hypertension cure in PA patients. 7,15,39,40 Female, shorter duration of hypertension, fewer number of antihypertensive drugs, and lower BMI are common predictors of hypertension cure. 7,15,39,40 Furthermore, external validation studies have shown the usefulness of these predictive models.…”

“…7,15,39,40 Female, shorter duration of hypertension, fewer number of antihypertensive drugs, and lower BMI are common predictors of hypertension cure. 7,15,39,40 Furthermore, external validation studies have shown the usefulness of these predictive models. 7,40 Counseling based on these models regarding probability of hypertension cure is recommended before surgery.…”

“…7,15,39,40 Furthermore, external validation studies have shown the usefulness of these predictive models. 7,40 Counseling based on these models regarding probability of hypertension cure is recommended before surgery. 41 Based on the PASO study consensus, BP and serum potassium levels should be measured within the first 3 months postoperatively for adequate antihypertensive treatment and, if necessary, potassium replacement.…”