Surgical Treatment Of Resistant Hypertension Combined With Primary Hyperaldosteronism Due To Adrenal Hyperplasia

Objective:The resistant hypertension(RH)is defined as uncontrolled hypertension despite treatment with at least 3 antihypertensive drugs at its optimal dose,including a diuretic,or controlled hypertension with at least 4 drug classes.Resistant hypertension not only has the characteristics of stubborn blood pressure,but also increases the risk of damage of target organs.Therefore,the study and treatment of RH and to bring blood pressure under control could remarkably improve the prognosis of patients.Among patients with RH,there exists a subgroup which is secondary to other diseases such as adrenal hypertension,renovascular hypertension(RVH)and obstructive sleep apnea hypopnea syndrome(OSAHS).Primary hyperaldosteronism caused by adrenocortical adenoma and adrenal hyperplasia is one of the main causes of secondary hypertension.Laparoscopic unilateral adrenalectomy for primary hyperaldosteronism due to adrenocortical adenoma is effective.While the therapeutic effect of adrenalectomy for RH secondary to primary hyperaldosteronism due to adrenal hyperplasia has not been well defined.The aim of this study was to evaluate the therapeutic effect of laparoscopic unilateral adrenalectomy for resistant hypertension combined with primary hyperaldosteronism due to adrenal hyperplasia.Methods:A total of 66 resistant hypertension patients combined with primary hyperaldosteronism due to unilateral or bilateral adrenal hyperplasia were entered in this retrospective analysis.All 66 patients met the diagnostic criteria for resistant hypertension.Adrenal hyperplasia was proved by multi-slice computed tomography(MSCT).Laboratory examinations were performed to diagnose the primary hyperaldosteronism.All patients had undergone laparoscopic unilateral adrenalectomy without severe complications,between January 2012 and December 2017.Data of the clinical information,the change of blood pressure and the antihypertensive medication were recorded and analyzed statistically.Results:Of the 66 patients,there were 45 males and 21 females,with the age of 43.35±11.37.All the patients took 3.64±0.99 types of antihypertensive drugs,and the blood pressure was 131.68±10.88/82.06±7.16 mmHg before the operation.These medications included CCB,ACEI,angiotensin receptor blockers(ARB),beta blockers and diuretics.All 66 patients underwent laparoscopic unilateral adrenalectomy.At the median follow-up of 46 months,the blood pressure of all patients was 137.72±10.42/85.95±7.41 mmHg by taking 1.42±0.91 antihypertensive drugs.Of the 66 patients,9.1%were cured,66.7%improved and 24.2%failed.All of the 66 patients were divided into 6 groups according to the time after the operation.They were:3 months-1 year,1 year-2 years,2 years-3 years,3 years-4 years,4 years-5 years and 5 years-6 years.The total effective rate was 100%for group 1,85.7%for group 2,91.7%for group 3,77.8%for group 4,55.5%for group 5 and 71.4%for group 6.However,univariate analysis of clinical information identified no pre-procedure predictor of treatment effect.Conclusions:Laparoscopic unilateral adrenalectomy achieved persistent improvement of resistant hypertension combined with primary hyperaldosteronism due to adrenal hyperplasia,without severe complications.Subsequent investigations are required to reveal the mechanism and clinical values of the operation in management of the resistant hypertension.