Arterial stiffness tied to clinical outcome, cardiorenal Injury in lateralized primary aldosteronism

An association exists between preoperative severe arterial stiffness and absence of complete clinical success in lateralized primary aldosteronism (PA) patients following adrenalectomy, a study has found. Such effect may play a role in cardiorenal injury, which partially explains kidney function deterioration and reduced regression of heart mass.

The investigators hypothesized that arterial stiffness estimated by brachial-ankle pulse wave velocity (baPWV) before adrenalectomy was associated with the clinical outcomes and cardiorenal injury in lateralized PA patients after adrenalectomy.

To test this hypothesis, they carried out a retrospective observational cohort study and included lateralized PA patients who had undergone adrenalectomy between 2013 and 2016 from the Taiwan Primary Aldosteronism Investigation database.

Complete clinical success at 1 year after adrenalectomy was the primary outcome. The secondary outcome was estimated glomerular filtration rate declining over 20 percent and improved left ventricular mass index.

Of the 221 patients with lateralized PA (mean age, 51.9 years; 50.7 percent men) included, 101 (45.7 percent) achieved complete clinical success at the 1-year follow-up assessment after adrenalectomy. In multivariate logistic regression analysis, lower baPWV before adrenalectomy was associated with higher likelihood of complete clinical success (odds ratio, 0.998, 95 percent confidence interval, 0.996–0.999; p=0.003).

Preoperative baPWV <1,600 cm/sec significantly correlated with complete cure of hypertension in multifactorial adjusted generalized additive model. Additionally, higher preoperative baPWV correlated with renal function decline and less left ventricular mass regression after adrenalectomy in lateralized PA patients during the follow-up period.