ArticleEndocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists2026
Primary Aldosteronism Surgery Outcomes Under Current Blood Pressure Guidelines.
Article in Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveHistorical studies report complete clinical success rates of 37% following adrenalectomy for primary aldosteronism (PA), based on the former blood pressure (BP) threshold of <140/90 mmHg. This study evaluated outcomes using the current guideline BP threshold of <130/80 mmHg.
methodsWe conducted a retrospective cohort study using the Epic COSMOS database of 1320 adults who underwent adrenalectomy for PA (2013-2024). Inclusion criteria included preoperative plasma aldosterone measurement and ambulatory BP measurements within 6 months and 6-18 months post-adrenalectomy. After excluding patients who had pre-adrenalectomy BP < 130/80 mmHg without antihypertensive therapy, 1079 patients were analyzed.
resultsComplete clinical success (BP < 130/80 mmHg without medications post-adrenalectomy) occurred in 16.5% (178/1079; 95% CI: 14.3-18.7). Partial clinical success (improved BP control and/or reduced medications post-adrenalectomy) was achieved by 73.5% (793/1079; 95% CI: 70.9-76.1). Absent clinical success occurred in 10% (108/1079; 95% CI: 8.2-11.8). The combined rate of complete and partial clinical success was 90% (971/1079; 95% CI: 88.2-91.8). Multivariable logistic regression identified significant predictors of absence of complete clinical success: more preoperative antihypertensive medications (P < .001), higher social vulnerability (P = .02), and higher baseline systolic (P = .01) and diastolic BP (P = .003). Age, gender, race, body mass index, stroke history, sleep apnea, pre-adrenalectomy serum potassium, and estimated glomerular filtration rate were not significantly associated with outcomes.
conclusionWhen applying current BP guidelines, 90% of patients achieve complete or partial clinical success after adrenalectomy for PA, demonstrating meaningful clinical outcomes. However, complete clinical success occurs in fewer patients (16.5%) than previously reported under traditional thresholds.
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