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

Autor: Araujo-Castro M; Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS).; University of Alcalá, Madrid., Paja Fano M; Endocrinology & Nutrition Department, OSI Bilbao-Basurto, Hospital Universitario de Basurto, Bilbao, Spain & Basque Country University, Medicine Department, Bilbao., González Boillos M; Endocrinology & Nutrition Department. Hospital Universitario de Castellón, Castellón., Pla Peris B; Endocrinology & Nutrition Department. Hospital Universitario de Castellón, Castellón., Pascual-Corrales E; Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)., García Cano AM; Biochemistry Department, Hospital Universitario Ramón y Cajal, Madrid., Parra Ramírez P; Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid., Martín Rojas-Marcos P; Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid., Ruiz-Sanchez JG; Endocrinology & Nutrition Department, Hospital Universitario Fundación Jiménez Díaz, Madrid., Vicente Delgado A; Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo., Gómez Hoyos E; Endocrinology & Nutrition Department, Hospital Universitario de Valladolid, Valladolid., Ferreira R; Endocrinology & Nutrition Department., García Sanz I; General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid., Recasens Sala M; Endocrinology & Nutrition Department, Institut Català de la Salut Girona, Girona., Barahona San Millan R; Endocrinology & Nutrition Department, Institut Català de la Salut Girona, Girona., Picón César MJ; Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Victoria de Málaga, IBIMA Malaga, CIBEROBN, Madrid., Díaz Guardiola P; Endocrinology & Nutrition Department, Hospital Universitario Infanta Sofía., García González JJ; Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, Sevilla., Perdomo CM; Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona., Manjón Miguélez L; Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)., García Centeno R; Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid., Percovich JC; Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid., Rebollo Román Á; Endocrinology & Nutrition Department, Hospital Reina Sofía, Córdoba., Gracia Gimeno P; Endocrinology & Nutrition Department, Hospital Rollo Villanueva, Zaragoza., Robles Lázaro C; Endocrinology & Nutrition Department, Complejo Universitario de Salamanca, Salamanca., Morales-Ruiz M; Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd., Hanzu FA; Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Journal of hypertension [J Hypertens] 2022 Dec 01; Vol. 40 (12), pp. 2486-2493. Date of Electronic Publication: 2022 Aug 23.
DOI: 10.1097/HJH.0000000000003284
Abstrakt: 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 ± 10.9 years) with PA who underwent unilateral adrenalectomy were included. After a mean follow-up of 29.1 ± 30.43 months after surgery, hypertension cure was obtained in 37.7% ( n  = 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.
(Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze: MEDLINE
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