Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan
Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan
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DOI：
10.1291/hypres.27.193
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发表时间：
2004-03-01
影响因子：
5.4
通讯作者：
Nishikawa, T
中科院分区：
文献类型：
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作者：
Omura, M;Saito, J;Nishikawa, T
继发性高血压（SH）包括内分泌高血压已报道罕见。我们估计了高血压患者中SH的患病率。我们前瞻性研究了1020例高血压患者。作为初步筛选，我们测量了血浆醛固酮浓度、血浆肾素活性、血清皮质醇浓度和血浆儿茶酚胺浓度，并进行了腹部超声检查（US）。作为二次筛查，我们进行了速尿加直立试验、卡托普利肾造影、地塞米松抑制试验、24小时尿儿茶酚胺测定和腹部CT。最后，除特发性醛固酮增多症、嗜铬细胞瘤和库欣综合征外，原发性醛固酮增多症均通过手术标本的组织病理学检查确诊。特发性醛固酮增多症的临床诊断为促肾上腺皮质激素（ACTH）刺激肾上腺静脉取样和肾动脉造影肾血管性高血压。原发性醛固酮增多症61例，肾血管性高血压5例，库欣综合征11例，临床前库欣综合征10例，嗜铬细胞瘤6例，1020例高血压患者中SH患病率为9.1%。在93例SH患者中，76例（82%）的高血压在单侧肾上腺切除术、经蝶垂体腺切除术或经皮腔内血管成形术后治愈或改善。除US和CT外，所有的初筛和二次筛检对SH和原发性高血压（EH）的鉴别均具有敏感性和特异性。总之，各种激素浓度的测量对于排除SH非常敏感，在本研究中，SH几乎没有特定的体征或症状，而CT和US检查并不总是有助于区分SH和EH。在本研究中，通过我们简单的筛选试验方法，高血压患者中可治愈的SH患病率高于以往的报道。高血压患者应筛查SH，并适当治疗基础疾病，以避免长期使用降压药和动脉粥样硬化并发症的风险。
Secondary hypertension (SH) including endocrine hypertension has been reported to be uncommon. We estimated the prevalence of SH among hypertensive patients. We prospectively studied 1,020 hypertensive patients. As an initial screening, we measured plasma aldosterone concentration, plasma renin activity, serum cortisol concentration and plasma catecholamine concentration and conducted abdominal ultrasonography (US). As a secondary screening, we performed furosemide plus upright test, captopril renography, dexamethasone suppression test, 24-h urine catecholamine measurement and abdominal CT. Finally, primary aldosteronism with the exception of idiopathic hyperaldosteronism, pheochromocytoma, and Cushing's syndrome were diagnosed by histopathological examination of surgical specimens. Idiopathic hyperaldosteronism was clinically diagnosed by adrenocorticotrophic hormone (ACTH)-stimulated adrenal venous sampling and renovascular hypertension by renal arteriography. There were 61 patients with primary aldosteronism, 5 with renovascular hypertension, 11 with Cushing's syndrome, 10 with preclinical Cushing's syndrome and 6 with pheochromocytoma, and the prevalence of SH was 9.1% among 1,020 hypertensive patients. In 76 (82%) of 93 patients with SH, hypertension was cured or improved after unilateral adrenalectomy, transsphenoidal pituitary adenectomy or percutaneous transluminal angioplasty. With the exception of US and CT, all initial and secondary screening tests were found to be sensitive and specific for differentiating SH from essential hypertension (EH). In conclusion, the measurement of various hormone concentrations was very sensitive for ruling out SH-a condition for which, in the present study, there were few specific signs or symptoms-while CT and US examinations were not always useful for differentiating SH from EH. The prevalence of curable SH among hypertensive subjects was higher in this study, which was conducted by our simple method of screening tests, than in previous reports. Hypertensive patients should be screened for SH and the underlying disease treated appropriately to avoid long-term use of antihypertensive drugs and risks of atherosclerotic complications.