AIMS: We aimed at determining the rate of drug-resistant arterial hypertension in patients with an unambiguous diagnosis of primary aldosteronism (PA). Moreover, we sought for investigating the diagnostic performance of adrenal vein sampling (AVS), and the effect of adrenalectomy on blood pressure (BP) and prior treatment resistance in PA patients subtyped by AVS in major referral centres. METHODS AND RESULTS: The Adrenal Vein Sampling International Study-2 (AVIS-2) was a multicentre international study that recruited consecutive PA patients submitted to AVS, according to current guidelines, during 15 years. The patients were over 18 years old with arterial hypertension and had an unambiguous diagnosis of PA. The rate of resistant hypertension was assessed at baseline and after adrenalectomy using the American Heart Association (AHA) 2018 definition. Information on presence or absence of resistant hypertension was available in 89% of the 1625 enrolled PA patients. Based on the AHA 2018 criteria, resistant hypertension was found in 20% of patients, of which about two-thirds (14%) were men and one-third (6%) women (χ2 = 17.1, P < 1*10-4) with a higher rate of RH in men than in women (23% vs. 15% P < 1*10-4). Of the 292 patients with resistant hypertension, 98 (34%) underwent unilateral AVS-guided adrenalectomy, which resolved BP resistance to antihypertensive treatment in all. CONCLUSIONS: (i) Resistant hypertension is a common presentation in patients seeking surgical cure of PA; (ii) AVS is key for the optimal management of patients with PA due to resistant hypertension; and (iii) AVS-guided adrenalectomy allowed resolution of treatment-resistant hypertension.

3rd Department of Medicine Charles University Prague General Hospital Prague Czech Republic

AP HP Hôpital Européen Georges Pompidou Hypertension Department and DMU CARTE F 75015 Paris France

Centre for Endocrinology and Metabolism Hudson Institute of Medical Research Clayton Victoria Australia

Clinical Research Institute of Endocrinology and Metabolic Diseases National Hospital Organization Kyoto Medical Center and Endocrine Center Ijinkai Takeda General Hospital Kyoto Japan

Department of Endocrinology Diabetes and Metabolic Diseases University Medical Centre Ljubljana Zaloska 7 1525 Ljubljana Slovenia

Department of Endocrinology University of St Petersburg Russia

Department of Internal Medicine Azienda Unità Sanitaria Locale IRCCS Arcispedale S Maria Nuova Hypertension Unit Reggio Emilia Italy

Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan

Department of Internal Medicine Radboud University Nijmegen Nijmegen Netherlands

Department of Medicine DIMED Emergency and Hypertension Unit University of Padova University Hospital via Giustiniani 2 35126 Padova Italy

Department of Medicine Monash University Clayton Victoria Australia

Department of Nephrology Endocrinology and Vascular Medicine Tohoku University Hospital Sendai Japan

Department of Nephrology Medical Faculty Heinrich Heine University Düsseldorf Germany

Division of Endocrinology and Metabolism Rostock University Medical Center Ernst Heydemann Str 6 18057 Rostock Germany

Endocrinology in Charlottenburg Berlin Germany

Faculty of Medicine University of Ljubljana Vrazov trg 2 1000 Ljubljana Slovenia

Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow UK

Institute of Clinical Endocrinology Tokyo Women's Medical University Tokyo Japan

Medical College of Wisconsin Endocrinology Center North Hills Health Center Menomonee Falls WI 53051 USA

Medizinische Klinik und Poliklinik 4 Klinikum der Universität München LMU München München Germany

Nephrology Department Hypertension Unit Hospital del Mar Universitat Autònoma de Barcelona Barcelona Spain

Université de Paris INSERM CIC1418 and UMR 970 F 75015 Paris France

University of Calgary Foothills Medical Centre Calgary Canada

Eur J Prev Cardiol. 2022 Mar 11;29(2):e82-e84. doi: 10.1093/eurjpc/zwaa124. PubMed

References provided by Crossref.org

Subtype Identification of Surgically Curable Primary Aldosteronism During Treatment With Mineralocorticoid Receptor Blockade