Heightened Cardiovascular Risk in Hypertension Associated With Renin-Independent Aldosteronism Versus Renin-Dependent Aldosteronism: A Collaborative Study.
Heightened Cardiovascular Risk in Hypertension Associated With Renin-Independent Aldosteronism Versus Renin-Dependent Aldosteronism: A Collaborative Study.
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与肾素非依赖性醛固酮增多症和肾素依赖性醛固酮增多症相关的高血压心血管风险增加：一项合作研究
DOI：
10.1161/jaha.121.023082
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发表时间：
2021-12-21
影响因子：
5.4
通讯作者：
Yang, Shumin
中科院分区：
文献类型：
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作者：
Hu, Jinbo;Shen, Hang;Huo, Peiqi;Yang, Jun;Fuller, Peter J.;Wang, Kanran;Yang, Yi;Ma, Linqiang;Cheng, Qingfeng;Gong, Lilin;He, Wenwen;Luo, Ting;Mei, Mei;Wang, Yue;Du, Zhipeng;Luo, Rong;Cai, Jun;Li, Qifu;Song, Ying;Yang, Shumin
关键词：
虽然肾素依赖性和非肾素依赖性醛固酮分泌都有助于醛固酮增多症，但尚未研究其与心血管疾病（CVD）风险的相关性。共有2909名来自FOS（FOS后代研究）的参与者参加了第六个检查周期，并随访至2014年，他们没有CVD，基线，血清醛固酮浓度和血浆肾素浓度。我们进一步从CONPASS（重庆原发性醛固酮增多症研究）中招募了2612名高血压受试者。在CONPASS中进行了Captopril激发试验，以确认肾素依赖性或非依赖性醛固酮增多症。在1433例FOS高血压患者中，与血清醛固酮浓度<10 ng dL-1的患者相比，（正常醛固酮），血清醛固酮浓度≥10 ng dL−1且血浆肾素浓度≤15 mIU L−1的受试者（确定为非肾素依赖性醛固酮增多症）显示CVD风险较高（风险比，1.40 [95% CI，1.08-1.82]），而血清醛固酮浓度≥10 ng dL−1和血浆肾素浓度>15 mIU L−1的患者（确定为肾素依赖性醛固酮增多症）显示CVD风险不变。在CONPASS研究中，非肾素依赖性醛固酮增多症的CVD风险显著高于正常醛固酮（比值比，2.57 [95%CI，1.13-5.86]），而在肾素依赖性醛固酮增多症中CVD风险保持不变。尿钾钠排泄比升高（反映盐皮质激素受体活性）仅在非肾素依赖性醛固酮增多症受试者中观察到。在高血压患者中，非肾素依赖性醛固酮增多症与CVD风险的关系比肾素依赖性醛固酮增多症更密切。
While both renin‐dependent and renin‐independent aldosterone secretion contribute to aldosteronism, their relative associations with cardiovascular disease (CVD) risk has not been investigated. A total of 2909 participants from the FOS (Framingham Offspring Study) with baseline, serum aldosterone concentration, and plasma renin concentration who attended the sixth examination cycle and were followed up until 2014 and who were free of CVD were included. We further recruited 2612 hypertensive participants from the CONPASS (Chongqing Primary Aldosteronism Study). Captopril challenge test was performed to confirm renin‐dependent or ‐independent aldosteronism in CONPASS. Among 1433 hypertensive subjects of FOS, when compared with those with serum aldosterone concentration <10 ng dL−1 (normal aldosterone), participants who had serum aldosterone concentration ≥10 ng dL−1 and plasma renin concentration ≤15 mIU L−1 (identified as renin‐independent aldosteronism) showed a higher risk of CVD (hazard ratio, 1.40 [95% CI, 1.08–1.82]), while those who had serum aldosterone concentration ≥10 ng dL−1 and plasma renin concentration >15 mIU L−1 (identified as renin‐dependent aldosteronism) showed an unchanged CVD risk. In CONPASS, renin‐independent aldosteronism carried a significantly higher risk of CVD than normal aldosterone (odds ratio, 2.57 [95% CI, 1.13–5.86]), while the CVD risk remained unchanged in renin‐dependent aldosteronism. Elevation of the urinary potassium‐to‐sodium excretion ratio, reflective of mineralocorticoid receptor activity, was only observed in participants with renin‐independent aldosteronism. Among patients with hypertension, renin‐independent aldosteronism is more closely associated with CVD risk than renin‐dependent aldosteronism.