What are the indications of persistent hypertension (HTN) after adrenal surgery in the treatment of primary aldosteronism, and what is the affect of adrenalectomy on the incidence of atrial fibrillation?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Persistence of HTN following apparent surgical treatment of lateralizable disease is most common in patients older than 45 years, in those who had HTN for more than 5 years prior to surgery, and in persons who did not respond preoperatively to spironolactone. [50, 51]

Persistent HTN may be related to resetting of baroreceptors, established hemodynamic changes, structural changes in the blood vessels, or coincidental essential HTN.

Another possibility to consider in persistent HTN is an incomplete resection of the adenoma, with remaining remnant hyperplastic tissue. The coexistence of hypertensive nephrosclerosis in some patients with persistent HTN is also a distinct possibility. The coexistence of other secondary causes of HTN needs to be considered as well; renal artery stenosis is an important consideration.

A study by Pan et al indicated that in patients with primary aldosteronism who are treated with adrenalectomy, the incidence of new-onset atrial fibrillation (NOAF) is lower than in patients with essential hypertension. However, the investigators also reported that lower-dose mineralocorticoid antagonist therapy in study patients with primary aldosteronism did not have a significant impact on NOAF incidence compared with cases of essential hypertension. [53]


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