Clinical Outcomes of 1625 Patients with Primary Aldosteronism Subtyped with Adrenal Vein Sampling

Gian Paolo Rossi, Giacomo Rossitto, Laurence Amar, Michel Azizi, Anna Riester, Martin Reincke, Christoph Degenhart, Jiri Widimsky, Mitsuhide Naruse, Jaap Deinum, Leo Schultze Kool, Tomaz Kocjan, Aurelio Negro, Ermanno Rossi, Gregory Kline, Akiyo Tanabe, Fumitoshi Satoh, Lars Christian Rump, Oliver Vonend, Holger S. WillenbergPeter J. Fuller, Jun Yang, Nicholas Yong Nian Chee, Steven B. Magill, Zulfiya Shafigullina, Marcus Quinkler, Anna Oliveras, Kwan Dun Wu, Vin Cent Wu, Zusana Kratka, Giulio Barbiero, Michele Battistel, Chin Chen Chang, Paul Emmanuel Vanderriele, Achille C. Pessina

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

Abstract

We sought to measure the clinical benefits of adrenal venous sampling (AVS), a test recommended by guidelines for primary aldosteronism (PA) patients seeking surgical cure, in a large registry of PA patients submitted to AVS. Data of 1625 consecutive patients submitted to AVS in 19 tertiary referral centers located in Asia, Australia, Europe, and North America were collected in a large multicenter international registry. The primary end points were the rate of bilateral success, ascertained lateralization of PA, adrenalectomy, and of cured arterial hypertension among AVS-guided and non AVS-guided adrenalectomy patients. AVS was successful in 80.1% of all cases but allowed identification of unilateral PA in only 45.5% by the criteria in use at each center. Adrenalectomy was performed in 41.8% of all patients and cured arterial hypertension in 19.6% of the patients, 2-fold more frequently in women than men (P<0.001). When AVS-guided, surgery provided a higher rate of cure of hypertension than when non-AVS-guided (40.0% versus 30.5%; P=0.027). Compared with surgical cases, patients treated medically needed more antihypertensive medications (P<0.001) and exhibited a higher rate of persistent hypokalemia requiring potassium supplementation (4.9% versus 2.3%; P<0.01). The low rate of adrenalectomy and cure of hypertension in PA patients seeking surgical cure indicates suboptimal AVS use, possibly related to issues in patient selection, technical success, and AVS data interpretation. Given the better outcomes of AVS-guided adrenalectomy, these results call for actions to improve the diagnostic use of this test that is necessary for detection of surgical PA candidates. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT01234220.

Original languageEnglish
Pages (from-to)800-808
Number of pages9
JournalHypertension
Volume74
Issue number4
DOIs
Publication statusPublished - 2019 Oct 1

Keywords

  • adrenal vein sampling
  • adrenalectomy
  • diagnosis
  • hypertension
  • patient selection
  • potassium
  • subtyping

ASJC Scopus subject areas

  • Internal Medicine

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