Primary Aldosteronism Surgery Outcomes Under Current Blood Pressure Guidelines
Authors' conclusion
When applying current BP guidelines, 90% of patients achieve complete or partial clinical success after adrenalectomy for PA, demonstrating meaningful clinical outcomes. However, complete clinical success occurs in fewer patients (16.5%) than previously reported under traditional thresholds.
Study context
- Population
- Adults who underwent adrenalectomy for primary aldosteronism (PA) (2013–2024), Epic COSMOS database, with preoperative plasma aldosterone and ambulatory blood pressure (BP) measurements within 6 months and 6–18 months post-adrenalectomy; excluding pre-adrenalectomy BP <130/80 mmHg without antihypertensive therapy1,079 analysed
- Participants
- 1,320 adults
- Outcome
- Complete clinical success: BP <130/80 mmHg without medications post-adrenalectomy
Main finding
As reported in the abstract
Complete clinical success (BP <130/80 mmHg without medications)
Complete clinical success
16.5%
178/1079; 95% CI: 14.3–18.7
Observational data: associations, not effects.
Further findings
Partial clinical success (improved BP control and/or reduced medications)
- Partial clinical success
- 73.5% (793/1079; 95% CI: 70.9-76.1)
Absent clinical success
- Absent clinical success
- 10% (108/1079; 95% CI: 8.2-11.8)
Complete or partial clinical success
- Combined complete and partial clinical success
- 90% (971/1079; 95% CI: 88.2-91.8)
Predictors of absence of complete clinical success (multivariable logistic regression)
- More preoperative antihypertensive medications
- P < 0.001
- Higher social vulnerability
- P = 0.02
- Higher baseline systolic BP
- P = 0.01
- Higher baseline diastolic BP
- P = 0.003
- Age, gender, race, BMI, stroke history, sleep apnea, pre-adrenalectomy serum potassium and eGFR not significantly associated with outcomes
Original publication
Primary Aldosteronism Surgery Outcomes Under Current Blood Pressure Guidelines. Endocr Pract. Published 11 September 2025. doi:10.
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