Predictors of Clinical Success After Surgery for Primary Aldosteronism in the Japanese Nationwide Cohort

CONTEXT: Aldosterone-producing adenomas are a curable subtype of primary aldosteronism (PA); however, hypertension persists in some patients after adrenalectomy. OBJECTIVE: To identify factors associated with, and develop prediction models for, blood pressure (BP) normalization or improvement after adrenalectomy. DESIGN: Retrospective analysis of patients treated between 2006 and 2018, with a 6-month follow-up. SETTING: A nationwide, 29-center Japanese registry encompassing 15 university hospitals and 14 city hospitals. PATIENTS: We categorized 574 participants in the Japan Primary Aldosteronism Study, who were diagnosed with PA and underwent adrenalectomy, as BP normalized or improved, on the basis of their presentations at 6 months postsurgery. MAIN OUTCOME MEASURE: The rate of complete, partial, and absent clinical success. Predictive factors related to BP outcomes after PA surgery were also evaluated. RESULTS: Complete clinical success was achieved in 32.6% and partial clinical success was achieved in 53.0% of the patients at 6 months postsurgery. The following five variables were independent predictors for BP normalization: ≤7 years of hypertension, body mass index ≤25 kg/m(2), no more than one antihypertensive medication, absence of medical history of diabetes, and female sex. The area under the receiver operator characteristic curve was 0.797 in the BP normalization model. CONCLUSION: We established models that predicted postoperative BP normalization in patients with PA. These should be useful for shared decision-making regarding adrenalectomy for PA.