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Background <p>Primary aldosteronism (PA) can be treated surgically or medically depending on disease lateralization and surgical candidacy. There is a dearth of data directly comparing antihypertensive medication trajectories and costs between these strategies.</p> Patients and Methods <p>We performed a retrospective cohort study of patients with new PA diagnoses and adrenal vein sampling to assess antihypertensive medication outcomes and treatment costs using Optum’s de-identified Clinformatics<sup>®</sup> Data Mart Database (2004–2022). Patients were stratified by receipt of adrenalectomy versus medical management alone. The index time point was defined as adrenal vein sampling (AVS) for medically managed and adrenalectomy for surgically managed patients. Outcomes were assessed using regression models.</p> Results <p>Of 911 patients, 52% underwent adrenalectomy and 48% medical therapy. Adrenalectomy patients were younger, with higher Elixhauser scores. Antihypertensive medication use (2.9 versus 2.8, <i>p</i> = 0.636) and costs did not differ at index. After 1 year, adrenalectomy patients used fewer antihypertensive medications (1.5 ± 1.4) than medically managed patients (2.5±1.5, <i>p</i> &lt; 0.001). On regression, age (<i>β</i> = 0.02, <i>p</i> = 0.002), male sex (<i>β</i> = 0.40, <i>p</i> &lt; 0.001), and baseline antihypertensive medications (<i>β</i> = 0.43, <i>p</i> &lt; 0.001) were associated with higher antihypertensive medication requirement. Adrenalectomy patients were prescribed 1.11 fewer antihypertensive medications at one year (<i>p</i> &lt; 0.001). In the resistant hypertension subcohort, adrenalectomy reduced antihypertensive medications by 1.35 (<i>p</i> &lt; 0.001). Adrenalectomy was associated with US $908 lower antihypertensive medication prescription costs (<i>p</i> &lt; 0.001) and 87% lower odds of potassium supplementation (<i>p</i> &lt; 0.001).</p> Conclusions <p>Patients with PA who undergo adrenalectomy demonstrate a significant reduction in antihypertensive medications compared with medically managed patients. While there is significant upfront cost to surgical intervention, reduced long-term prescription costs are realized.</p>

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Fewer Pills, Lower Bills: Antihypertensive and Cost Outcomes of Adrenalectomy in Primary Aldosteronism

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月4日

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  • Jesse E. Passman,
  • Lily Owei,
  • Colleen Brensinger,
  • Taryn Barrett,
  • Lauren R. Kelz,
  • Jasmine Hwang,
  • Jordana B. Cohen,
  • Heather Wachtel

摘要

Background

Primary aldosteronism (PA) can be treated surgically or medically depending on disease lateralization and surgical candidacy. There is a dearth of data directly comparing antihypertensive medication trajectories and costs between these strategies.

Patients and Methods

We performed a retrospective cohort study of patients with new PA diagnoses and adrenal vein sampling to assess antihypertensive medication outcomes and treatment costs using Optum’s de-identified Clinformatics® Data Mart Database (2004–2022). Patients were stratified by receipt of adrenalectomy versus medical management alone. The index time point was defined as adrenal vein sampling (AVS) for medically managed and adrenalectomy for surgically managed patients. Outcomes were assessed using regression models.

Results

Of 911 patients, 52% underwent adrenalectomy and 48% medical therapy. Adrenalectomy patients were younger, with higher Elixhauser scores. Antihypertensive medication use (2.9 versus 2.8, p = 0.636) and costs did not differ at index. After 1 year, adrenalectomy patients used fewer antihypertensive medications (1.5 ± 1.4) than medically managed patients (2.5±1.5, p < 0.001). On regression, age (β = 0.02, p = 0.002), male sex (β = 0.40, p < 0.001), and baseline antihypertensive medications (β = 0.43, p < 0.001) were associated with higher antihypertensive medication requirement. Adrenalectomy patients were prescribed 1.11 fewer antihypertensive medications at one year (p < 0.001). In the resistant hypertension subcohort, adrenalectomy reduced antihypertensive medications by 1.35 (p < 0.001). Adrenalectomy was associated with US $908 lower antihypertensive medication prescription costs (p < 0.001) and 87% lower odds of potassium supplementation (p < 0.001).

Conclusions

Patients with PA who undergo adrenalectomy demonstrate a significant reduction in antihypertensive medications compared with medically managed patients. While there is significant upfront cost to surgical intervention, reduced long-term prescription costs are realized.