Introduction

Primary aldosteronism (PA) is one of the typical forms of secondary hypertension (HTN). Our previous study showed that the antihypertensive effect of laparoscopic adrenalectomy (LA) was not a little for elderly PA patients suffering from HTN for many years. However, the impact of LA on health-related quality of life (QOL) in those patients has not been evaluated.

Methods

According to Japanese diagnostic criteria for PA, a total of 178 PA patients who underwent LA between July 2012 and December 2015 were eligible for this study. Demographic data, perioperative outcomes and QOL were examined. QOL was assessed using the Short Form 36-Item Health Survey questionnaire before and at 6, 12, 18 and 24months after LA.

Results

Responses were analyzed for 96 of 136 patients (70.6%) who responded to the questionnaire. Median age was 55 years (range, 25-77 years) and median duration of HTN was 9 years (range, 1-43 years). Median follow-up was 12 months (range, 6-24 months) after LA. To evaluate the influence of the duration of HTN on health-related QOL, we compared differences in Norm-based Scoring in Japanese between patients with HTN for <10 years (median age, 51 years) and patients with HTN >10 years (median age, 60 years). In the former group, scores improved in all 8 health-related QOL domains from the baseline at the 6-month survey after LA (Figure A). In the latter group, scores of 4 domains did not improve in terms of Physical functioning, Bodily pain, Social functioning or Mental health. However, scores for another 4 domains improved from the baseline (Figure B). Furthermore no significant differences between groups were evident 6 months after LA in any domains scores.

Conclusions

To the best of our knowledge, normalizing aldosterone levels by LA contributes not only to antihypertensive effect, but also to protective effects against cardiovascular diseases. In our study, LA for PA patients with short-term HTN leads to much greater improvements in prognosis and QOL. However, improvements of QOL by LA was found among PA patients despite long-term use of HTN. The negative impact of LA for PA patients with long-term HTN on Social functioning and Mental health remains to be elucidated. More time is needed to evaluate the influence of LA on long-term QOL among PA patients with long-term HTN to achieve better outcomes from LA.

Funding

none