Use of a Japanese nomogram in predicting hypertension cure in patients with primary aldosteronism (PA) is fairly accurate, and the achieved cure rate is similar to established series, according to a study presented at the 13th Asian-Pacific Congress of Hypertension (APCH 2017) held in Singapore.

Researchers performed a retrospective cohort study of 79 patients (mean age 51.75 years) who underwent adrenalectomy for PA to assess hypertension cure in PA following surgery using a Japanese nomogram. They also collected demographic, pathological and treatment-related data.

Hypertension cure was defined as a blood pressure (BP) of <140/90 mm Hg without any hypertensive drugs at 12 months after surgery or at last follow-up. As propose by Utsumi and colleagues, nomogram was used to calculate the predicted cure rate. [World J Surg 2014;38:2640-4]

To determine the probability of postoperative hypertension cure in the nomogram, researchers used the formula P=1/[1+exp({-}Y)] where Y is 6.89723 + (?0.11534) x duration of hypertension + (?1.34816) x number of antihypertensive drug classes  + (?0.05030) x age + (?1.71899) x sex (male=1; female=0).

With a male:female ratio of 1:1, participants had a mean preoperative systolic (S)BP of 142 mm Hg. Of the patients, 31 (30 percent) were on a single class of antihypertensive medication, 41 (40 percent) on two classes and 36 (30 percent) on three or more classes of drugs.

Sixty-six (84 percent) patients achieved hypertension cure. Of these, five (6 percent) had reduction in the number and dosage of medications. There was a 45-percent probability of cure with laparoscopic adrenalectomy in this cohort using the Japanese nomogram model. [APCH 2017, abstract 5086]

These results are consistent with other published series, according to researchers. [Ann Surg 2008;247:511?518; Horm Metab Res 2012;44:221?2270]

Utsumi and colleagues developed the first nomogram that can accurately predict postoperative hypertension cure in patients with PA. Duration of hypertension, preoperative number of antihypertensive drug classes, age and sex were integrated into this nomogram as independent predictors of hypertension cure. [World J Surg 2014;38:2640-4]

“This nomogram can help clinicians calculate the probability of postoperative hypertension cure in patients with primary aldosteronism and objectively inform them of their hypertension outcome before laparoscopic adrenalectomy,” the Japanese researchers said.

One of the most common causes of secondary hypertension is PA, and the most common subtype of PA that can be cured by unilateral adrenalectomy is adenoma, according to researchers of the current study.

 “Not all patients with an adenoma have their hypertension cured completely by adrenalectomy. The cure rate of hypertension is variable and dependent on the selection of patients for operation,” they added.