Kazuyoshi Nakamura, Mayuko Kaga, Tomokazu Sazuka, Shinichi Sakamoto, Takashi Imamoto, Takahito Suyama, Takanobu Utsumi, Koji Kawamura, Yukio Naya, Naoki Nihei, Hiroyoshi Suzuki, Mitsuru Yanagisawa, Naoto Kamiya, and Tomohiko Ichikawa
INTRODUCTION AND OBJECTIVES: The number of antihypertensive drug classes used does not accurately reflect total consumption of antihypertensive drugs to control blood pressure (BP), although it can become one of predictors for postoperative hypertension outcome in patients with primary aldosteronism (PA). The defined daily dose (DDD) was adopted to analyze consumption of many prescribed drugs. The aim of this study was to use the DDD to assess postoperative changes in antihypertensive drug consumption in PA patients. METHODS: This retrospective study included 110 Japanese PA patients who underwent unilateral laparoscopic adrenalectomy between 1995 and 2012. Hyperaldosteronism was cured in all patients after surgery. After we defined the ratio of prescribed daily dose (PDD) to DDD (PDD/DDD) to estimate individual consumption of antihypertensive drugs, we calculated the preand postoperative PDD/DDD to assess total consumption change in antihypertensive drugs (Supplement). Uniand multivariate analyses were performed to identify clinical predictors for 75% decrease in total PDD/DDD. RESULTS: Total PDD/DDD decreased in 95.4% of patients postoperatively. The mean decrease in total PDD/DDD was 65.0%. A decrease in total PDD/DDD was significantly correlated with age, body mass index (BMI), duration of hypertension, estimated glomerular filtration rate (eGFR), and plasma renin activity (PRA). Postoperative decreases in total PDD/DDD 75% were confirmed in 52.7% of patients. Multivariate analysis identified no medical history of cardiovascular disease (odds ratio [OR] 5.4, P 0.02), lesser BMI (OR 1.2, P 0.03), and shorter duration of hypertension (OR 1.1, P 0.01) as independent predictors of postoperative decrease in total PDD/DDD 75%. Based on univariate analyses, additional factors associated with postoperative decrease in total PDD/DDD 75% included female sex, lower preoperative systolic BP, lower preoperative total PDD/DDD, greater eGFR, and lesser PRA (P 0.05). CONCLUSIONS: Total PDD/DDD was shown to be a useful tool to assess total consumption change of antihypertensive drugs in PA patients. Clinicians can explain the predicted postoperative change of antihypertensive drug consumption to PA patients in detail using total PDD/DDD.