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Patients who undergo medical treatment, in view of bilateral PA, or unilateral PA not keen for surgery, or indeterminate (lack of localisation on tests)

Patients with unilateral PA who underwent adrenalectomy

Adrenalectomy for unilateral adrenal hyperplasia / adenoma

Adrenalectomy

Troy Puar, MRCP (UK)

Majority of patients with hypertension have primary hypertension (without an underlying cause). Secondary hypertension (due to an underlying disease) is important to recognize, as treatment can lead to cure of hypertension. Primary aldosteronism (PA) is the most common cause of secondary hypertension, and can be found in 5-10% of patients locally.

PA is caused by excessive release of a hormone (aldosterone) from the adrenal glands, which can be unilateral (one gland) or bilateral (both glands). Distinction between two is crucial as unilateral disease is treated with the aim of cure by surgery, and bilateral disease is treated by medication.

It has been shown that excess aldosterone has other harmful effects in addition to hypertension, such as directly affecting the heart, blood vessels, kidneys, diabetes and quality of life. This is supported by studies showing reversal of these effects after treatment for PA. In addition, improvements after surgery appears to be superior to medical treatment, although studies have found variable results.

Hence, the investigators aim to accurately subtype patients with PA into unilateral or bilateral disease and study the post-treatment response after both surgery and medicine with regards to the effects on blood pressure, cardiovascular, renal, metabolic and quality of life.

Peripheral blood samples Adrenal vein blood samples (during adrenal vein sampling) Adrenal tissue (post-adrenalectomy)

Prospective Study Assessing Blood Pressure and Other Outcomes Post-treatment in Patients With Primary Aldosteronism

Prospective Study Assessing Blood Pressure, Cardiovascular, Endothelial and Other Outcomes poSt-surgical and Medical Treatment in Patients With Primary Aldosteronism

Blood pressure assessed by 24hr ambulatory BP

Use of antihypertension medications as expressed in daily defined dosages and total number of medications

change in serum creatinine, calculated GFR, albuminuria (prevalence and severity)

Proportion of patients reaching normal BP (ambulatory /home BP \<135/85 or clinic BP \<140/90)

Proportion of patients with cure of PA after adrenalectomy

Changi General Hospital

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Prospective Study Assessing Blood Pressure and Other Outcomes Post-treatment in Patients With Primary Aldosteronism	NCT03174847	Primary Aldoste... Primary Aldoste... Primary Aldoste...	Adrenalectomy Mineralocortico...	21 Years - 80 Years	Changi General Hospital
Prospective Study Assessing Blood Pressure and Other Outcomes Post-treatment in Patients With Primary Aldosteronism	NCT03174847	Primary Aldoste... Primary Aldoste... Primary Aldoste...	Adrenalectomy Mineralocortico...	21 Years - 80 Years	Changi General Hospital

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