Primary Aldosteronism: Practical Approach to Diagnosis and Management.
Primary Aldosteronism: Practical Approach to Diagnosis and Management.
复制标题
DOI：
10.1161/circulationaha.118.033597
复制
发表时间：
2018-08-21
期刊：
影响因子：
37.8
通讯作者：
Auchus RJ
中科院分区：
文献类型：
--
作者：
Byrd JB;Turcu AF;Auchus RJ
原发性醛固酮增多症（PA）是继发性高血压最常见的形式。在许多情况下，肾上腺细胞内离子通道和泵的体细胞突变启动了PA的发病机制，这一机制可能解释了PA如此普遍的原因，并表明一定存在更温和的进化形式的PA。与原发性高血压相比，PA引起更多的终末器官损害，并与心血管疾病的过度发病率相关，包括心力衰竭、卒中、非致死性心肌梗死和心房颤动。筛查简单且容易获得，靶向治疗可改善血压控制并减轻心血管发病率。尽管有这些必要，但PA的筛查率很低，而且矿皮质激素受体拮抗剂在高血压治疗中的应用不足。在总结了前列腺癌患病率及其相关心血管疾病的证据后，本文描述了一种实用的前列腺癌筛查、转诊和管理方法。所有治疗高血压的医生都应该常规筛查合适的患者。
Primary aldosteronism (PA) is the most common form of secondary hypertension. In many cases, somatic mutations in ion channels and pumps within adrenal cells initiate the pathogenesis of PA, and this mechanism might explain why PA is so common and suggests that milder and evolving forms of PA must exist. Compared with primary hypertension, PA causes more end-organ damage and is associated with excess cardiovascular morbidity, including heart failure, stroke, non-fatal myocardial infarction, and atrial fibrillation. Screening is simple and readily available, and targeted therapy improves blood pressure control and mitigates cardiovascular morbidity. Despite these imperatives, screening rates for PA are low, and mineralocorticoid-receptor antagonists are under-utilized for hypertension treatment. After summarizing the evidence for the prevalence of PA and its associated cardiovascular morbidity, a practical approach to PA screening, referral, and management is described. All physicians who treat hypertension should routinely screen appropriate patients for PA.