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Clinical presentation and surgical outcomes in primary aldosteronism differ by race
Author(s) -
Gershuni Victoria M.,
Ermer Jae P.,
Kelz Rachel R.,
Roses Robert E.,
Cohen Debbie L.,
Trerotola Scott O.,
Fraker Douglas L.,
Wachtel Heather
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25806
Subject(s) - medicine , primary aldosteronism , presentation (obstetrics) , race (biology) , general surgery , aldosterone , surgery , botany , biology
Background Primary aldosteronism (PA) is the most common cause of secondary hypertension; early diagnosis and intervention correlate with outcomes. We hypothesized that race may influence clinical presentation and outcomes. Methods We conducted a retrospective analysis of patients with PA (1997‐2017) who underwent adrenal vein sampling (AVS). Patients were classified by self‐reported race as black or non‐black. Improvement was defined as postoperative decrease in mean arterial pressure (MAP), antihypertensive medications (AHM), or both. Results Among patients undergoing AVS (n = 443), 287 underwent adrenalectomy. Black patients (28.2%) had higher body mass index (33.9 vs 31.8 kg/m 2 ; P = .01), longer median duration of hypertension (12 vs 10 years; P = .003), higher modified Elixhauser comorbidity index (2 vs 1; P = .004), and lower median income ($47 134 vs $78 280; P < .001). Black patients had similar aldosterone:renin ratios (150 vs 135.6 [ng/dL]/[ng·mL· −1 hr −1 ]; P = .23) compared to non‐blacks. At long‐term follow‐up, black patients had a similar requirement for AHM (1 vs 0; P = .13) but higher MAP (100.6 vs 95.3 mm Hg; P = .004). Conclusion Black patients present with longer duration of hypertension and more comorbidities. They are equally likely to lateralize on AVS, suggesting similar disease phenotype. However, black patients demonstrate less improvement with adrenalectomy; this may reflect a delay in diagnosis or concomitant essential hypertension.