***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Autonomous secretion of aldosterone in patients with primary aldosteronism increases glomerular filtration rate and causes kidney damage . The influence of a mild decrease in kidney function on residual hypertension after adrenalectomy is unexplored . STUDY DESIGN Nonconcurrent prospect i ve study . SETTING & PARTICIPANTS The study was based on the Taiwan Primary Aldosteronism Investigation ( TAIPAI ) data base . 150 patients ( 61 men ; overall mean age , 47.2 + /- 11.6 years ) with a diagnosis of aldosterone-producing adenoma had undergone unilateral adrenalectomy at National Taiwan University Hospital from July 1999 to January 2007 . PREDICTOR Presurgery estimated glomerular filtration rate ( eGFR ) . OUTCOMES & MEASUREMENTS Residual hypertension after adrenalectomy , defined either as less than 75 % of recorded blood pressure measurements with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg or requiring antihypertensive medications during the first year after surgery . RESULTS Before surgery , 27 ( 18 % ) , 72 ( 48 % ) , and 51 ( 34 % ) patients had moderately to severely decreased ( < 60 mL/min/1.73 m(2 ) ) , mildly decreased ( 60 < or= eGFR < 90 mL/min/1.73 m(2 ) ) , or nondecreased eGFR ( > or=90 mL/min/1.73 m(2 ) ) , respectively . After surgery , 16 ( 59.3 % ) , 29 ( 40.3 % ) , and 10 ( 19.3 % ) patients in each category had postsurgery residual hypertension . Compared with patients without decreased eGFR before surgery , adjusted odds ratios for postsurgery residual hypertension were 2.7 ( 95 % confidence interval , 1.03 to 7.0 ; P = 0.04 ) and 2.8 ( 95 % confidence interval , 1.05 to 9.3 ) for mildly and moderately to severely decreased eGFR , respectively . LIMITATIONS Arbitrary definition for residual hypertension . CONCLUSIONS Two-thirds of patients with aldosterone-producing adenoma were cured of hypertension by means of unilateral adrenalectomy . Kidney function impairment , even mild , appears to be associated with a high incidence of postsurgery residual hypertension Primary aldosteronism ( PA ) , a common cause of high blood pressure ( BP ) , induces left ventricular ( LV ) hypertrophy and an excess rate of cardiovascular events . Whether its treatment provides long-term cure of hypertension and regression of cardiovascular damage remains uncertain . To the aim of assessing the effect of treatment of PA on BP and LV changes , we prospect ively recruited 323 patients in a long-term follow-up study entailing serial echocardiography evaluations . Of them , 180 had PA and were assigned to either adrenalectomy ( n=110 ) or medical therapy ( n=70 ) on the basis of the adrenal vein sampling . The remaining 143 were consecutive optimally treated primary hypertensive patients . At baseline , the PA patients had more inappropriate LV mass  than PH patients ( 27.1 % versus 16.2 % ; P=0.020 ) , despite similar BP values . At a median follow-up of 36 months ( range , 6–225 ) , BP was lowered ( P<0.0001 versus baseline ) to similar values in adrenalectomized ( 135±15/83±9 mm Hg ) , medically treated PA ( 133±11/83±7 mm Hg ) , and PH ( 139±15/86±9 mm Hg ) patients . To this end , the adrenalectomized patients required significantly less drugs than the other groups . In PA patients , the LV mass index and the rate of LV hypertrophy fell through LV inward remodeling to the level of optimally treated PH patients , indicating that the LV work markedly decreased . Findings were similar when long-term ( ≥5 and ≥10 years ) data were examined . Thus , an early diagnosis and a specific treatment of PA warrant normalization of BP and reversal of detrimental LV changes at long term Background : Primary hyperaldosteronism is a frequent cause of resistant hypertension and is amenable to surgical intervention when caused by a unilateral aldosterone‐producing adenoma . The aim of this study was to investigate the long‐term results of laparoscopic adrenalectomy in the control of hypertension caused by primary hyperaldosteronism BACKGROUND Experimental and human studies demonstrate that long-term exposure to elevated aldosterone levels results in cardiac and vascular damage . METHODS We investigated long-term cardiovascular outcomes in patients with primary aldosteronism after surgical or medical treatment . Fifty-four patients with or without evidence of adrenal adenomas were prospect ively followed up for a mean of 7.4 years after treatment with adrenalectomy or spironolactone .  Patients with primary aldosteronism were compared with patients with essential hypertension and were treated to reach a blood pressure of less than 140/90 mm Hg . The main outcome measure was a combined cardiovascular end point comprising myocardial infa rct ion , stroke , any type of revascularization procedure , and sustained arrhythmias . RESULTS At baseline , the prevalence of cardiovascular events was greater in primary aldosteronism ( 35 % ) than in essential hypertension ( 11 % ) ( odds ratio , 4.61 ; 95 % confidence interval , 2.38 - 8.95 ; P < .001 ) , with odds ratios of 4.93 , 4.36 , and 2.80 for sustained arrhythmias , cerebrovascular events , and coronary heart disease , respectively . Blood pressure during follow-up was comparable in the primary aldosteronism and essential hypertension groups . Ten patients in the primary aldosteronism group and 19 in the essential hypertension group reached the primary end point ( P= .85 ) . Cox analysis indicated that older age and longer duration of hypertension were factors independently associated with the cardiovascular end point . Cardiovascular outcome was comparable in patients with aldosteronism treated with adrenalectomy vs aldosterone antagonists ( P= .71 ) . CONCLUSION Primary aldosteronism is associated with a cardiovascular complication rate out of proportion to blood pressure levels that benefits substantially from surgical and medical treatment in the long term Background Primary aldosteronism is the most common curable cause of secondary hypertension . Despite resection , however , many patients with primary aldosteronism continue to require antihypertensive drugs to control their blood pressure . Although many patients with primary aldosteronism want to know the postoperative probability of hypertension cure before surgery , there are no predictive models calculating its probability . We therefore developed a nomogram to predict hypertension cure in patients with primary aldosteronism after laparoscopic adrenalectomy . Methods We retrospectively surveyed 132 Japanese patients with primary aldosteronism who were treated by unilateral laparoscopic adrenalectomy .  Hypertension cure was defined as normal blood pressure ( < 140/90 mmHg ) without antihypertensive drugs 6 months postoperatively . We developed a novel nomogram that postoperatively predicted cured hypertension in 105 ( 80 % ) r and omly selected patients and vali date d it with the remaining 27 ( 20 % ) . Results At 6 months , blood pressure had normalized in 42 % of patients without antihypertensive drugs . Duration of hypertension , preoperative number of antihypertensive drug classes , age , and sex were incorporated into a novel nomogram as independent predictors of hypertension cure . The value of the area under the receiver operating characteristics curve for this nomogram was 0.83—which was significantly higher than that of the Aldosteronoma Resolution Score — on internal validation . Conclusions We developed the first nomogram that can accurately predict postoperative hypertension cure in patients with primary aldosteronism . This nomogram can help clinicians calculate the probability of postoperative hypertension cure in patients with primary aldosteronism and objective ly inform them of their hypertension outcome before laparoscopic adrenalectomy Background In patients with primary hyperaldosteronism , solitary adrenal adenomas are an indication for surgical intervention . In contrast , adrenal hyperplasia is almost exclusively treated by drugs . Patients and methods In a prospect i ve clinical study 183 patients ( 81 men , 102 women ; age 49.6 ± 12.8 years ) with Conn ’s syndrome were operated on using the posterior retroperitoneoscopic approach .  Tumor size ranged from 0.2 to 5.0 cm ( mean 1.5 ± 0.8 cm ) . Final histology described a solitary adenoma in 127 patients and adrenal hyperplasia in 56 patients .  Partial adrenalectomies were performed in 47 operations . Results The perioperative complication rate was 4 % , mortality zero . In none of the cases was conversion to open surgery necessary . The mean operating time was 58 ± 32 minutes ( range 20–230 minutes ) and was associated with sex ( p < 0.001 ) but not with the extent of resection ( partial vs. total , p = 0.51 ) or with tumor size ( ≤1.5 vs. > 1.5 cm ; p = 0.43 ) or tumor site ( p = 0.77 ) . Median blood loss was 15 ml . Median duration of postoperative hospitalization was 4 days . After a mean follow-up of nearly 5 years , 96 % of patients are normokalemic , 30 % of patients are cured ( normotensive without medication ) , and 87 % showed an improvement of hypertension ( normotensive without or with reduced medication ) . Cure of hypertension depended on the patient ’s age ( p < 0.001 ) and sex ( p < 0.001 ) , duration of hypertension ( p < 0.05 ) , and histomorphology ( p < 0.001 ) . Improvement of hypertension was not associated with any of these factors . Conclusions Retroperitoneoscopic removal of adrenal gl and s in patients with Conn ’s syndrome is a safe , rapidly performed surgical procedure and can thus be considered as first choice option for treatment of both solitary adrenal adenomas and hyperplasia presenting with a clinical ly predominating nodule OBJECTIVES The aim of this report was to show that the rate of cardiovascular events is increased in patients with either subtype of primary aldosteronism ( PA ) . BACKGROUND Primary aldosteronism involves hypertension ( HTN ) , hypokalemia , and low plasma renin . The two major PA subtypes are unilateral aldosterone-producing adenoma ( APA ) and bilateral adrenal hyperplasia . METHODS During a three-year period , the diagnosis of PA was made in 124 of 5,500 patients referred for comprehensive evaluation and management . Adenomas were diagnosed in 65 patients and idiopathic hyperaldosteronism in 59 patients . During the same period , clinical characteristics and cardiovascular events of this group were compared with those of 465 patients with essential hypertension ( EHT ) r and omly matched for age , gender , and systolic and diastolic blood pressure . RESULTS A history of stroke was found in 12.9 % of patients with PA and 3.4 % of patients with EHT ( odds ratio [ OR ] = 4.2 ; 95 % confidence interval [ CI ] 2.0 to 8.6 ] ) . Non-fatal myocardial infa rct ion was diagnosed in 4.0 % of patients with PA and in 0.6 % of patients with EHT ( OR = 6.5 ; 95 % CI 1.5 to 27.4 ) . A history of atrial fibrillation was diagnosed in 7.3 % of patients with PA and 0.6 % of patients with EHT ( OR = 12.1 ; 95 % CI 3.2 to 45.2 ) . The occurrence of cardiovascular complications was comparable in both subtypes of PA . CONCLUSIONS Patients presenting with PA experienced more cardiovascular events than did EHT patients independent of blood pressure . The presence of PA should be detected , not only to determine the cause of HTN , but also to prevent such complications Primary aldosteronism ( PA ) , an underdiagnosed cause of hypertension , is associated with more significant cardiac remodeling and myocardial fibrosis than is essential hypertension ( EH ) . The aim of this study was to vali date myocardial fibrosis and to evaluate factors associated with the degree of myocardial fibrosis in patients with PA . We prospect ively analyzed 62 patients with PA ( including 46 patients with aldosterone-producing adenoma and 16 with bilateral hyperplasia ) between October 2006 and October 2010 , and we enrolled 17 patients with EH as the control group .  Echocardiography , including ultrasonic tissue characterization using cyclic variation of integrated backscatter ( CVIBS ) , was performed in individuals in both groups . Among patients with PA , the diastolic blood pressures and plasma aldosterone concentrations were significantly higher than those of patients with EH . Moreover , the serum potassium levels and 
    Output:
    
Conclusions The hypertension cure rate for unilateral adrenalectomy in PA is not optimal .