Clinical Analyses Of Benign Adrenal Disorders With Hypertension

Background:Cardiovascular diseases,represented by hypertension,are threatening the human health.Primary aldosteronism is the main cause of secondary hypertension.And hypertension is the non-specific manifestation in some patients with hypercortisolism and pheochromocytoma.Non-functional adrenal tumors are associated with cardiovascular and cerebrovascular diseases such as hypertension and metabolic-related complications such as diabetes.Analyses on the clinical characteristics of patients with benign adrenal disorders,especially non-functional adrenal tumors,with hypertension and outcomes of blood pressure after adrenal surgery can be beneficial to the clinical practice.Objective:To evaluate the hypertension improvement after adrenalectomy in patients with benign adrenal disorders with hypertension and the related factorsMethods:The clinical data of 208 patients with benign adrenal disorders with hypertension in department of urology from 2016 to 2019 were retrospectively analyzed The relief of hypertension postoperatively was studied during the follow-up.Results:The mean duration of hypertension in all included patients with benign adrenal disorders was 8.40±7.88 years.The average SBP and DBP of all patients before operation was 138.75±16.64 mmHg and 83.41 ± 12.65 mmHg,respectively.During the follow-up,the average postoperative SBP and DBP was 130.79 ± 11.20 mmHg and 83.16±8.89 mmHg,respectively.The preoperative plasma aldosterone level was 283.36±187.92 pg/ml,the serum potassium level was 3.85±0.60 mmol/L,the serum cortisol level was 11.99±4.21 ?g/dl and the serum creatinine level was 70.15±25.75?mol/L.After adrenalectomy,hypertension of 98 patients was cured and 110 was uncured.Of the 110 patients,postoperative hypertension of 64 patients was improved.The average tumor size was 2.26±1.58 cm.The prognosis of postoperative hypertension was significantly different in patients with different adrenal disorders(p<0.001).Multivariate Logistics regression analysis showed that BMI(p=0.033),duration of hypertension(p=0.001)and tumor size(p=0.045)were correlated with the prognosis of postoperative hypertension among all patients.The cure rate of postoperative hypertension in patients with non-functional adrenal disorders was 22.8%,and the effective rate was 47.4%.Multivariate Logistics regression analysis of effective factors in patients with primary aldosteronism showed that the hypertension cure after adrenalectomy was related to the history of coronary heart disease(p=0.041),the duration of hypertension(p=0.013),preoperative use of no less than three antihypertensive drugs(p=0.006),serum potassium level(p=0.005)and surgical side(p=0.025).Conclusion:The cure rate of hypertension in patients with benign adrenal disorders after adrenalectomy varies significantly among different subtypes.The improvement rate of postoperative hypertension in patients with non-functional adrenal disorders is 47.4%,indicating that adrenalectomy for these patients is beneficial to improve the situation of blood pressure.The history of coronary heart disease,the duration of hypertension,no less than three kinds of antihypertensive drugs before operation,the serum potassium level and the side of surgery are related to hypertension cure of the patients with primary aldosteronism after adrenalectomy.These factors can be used as predictors to evaluate the prognosis of these patients.