The Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension: A Cohort Study.
The Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension: A Cohort Study.
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DOI：
10.7326/m17-0882
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发表时间：
2017-11-07
影响因子：
39.2
通讯作者：
Vaidya A
中科院分区：
文献类型：
--
作者：
Brown JM;Robinson-Cohen C;Luque-Fernandez MA;Allison MA;Baudrand R;Ix JH;Kestenbaum B;de Boer IH;Vaidya A
原发性醛固酮增多症被认为是“肾素依赖性醛固酮增多症”的一种严重形式，会导致盐皮质激素受体 (MR) 过度激活。旨在调查血压正常者中是否存在一系列亚临床的不依赖于肾素的醛固酮增多症，从而增加高血压的风险。队列研究。国家社区研究。动脉粥样硬化多种族研究中的 850 名未经治疗的血压正常参与者测量了血清醛固酮、血浆肾素活性 (PRA)。纵向分析调查了在 PRA 生理表型（抑制：≤0.50；不确定：0.51-0.99；未抑制：≥1.0 μg/L/h）背景下醛固酮浓度是否与高血压事件（定义为 SBP≥140、DBP≥90 mmHg）或开始抗高血压药物相关。横断面分析研究了醛固酮与 MR 活性的关联，通过血清钾和尿钾排泄分数进行评估。与其他 PRA 表型相比，肾素表型受抑制与较高的高血压发生率相关（每 1000 人年随访中分别为 85.4 [73.4, 99.3] 例 vs. 53.3 [42.8, 66.4] vs. 54.5 [41.8, 71.0] 例）。由于肾素抑制，较高的醛固酮浓度与发生高血压的风险增加独立相关。而当肾素未被抑制时，没有观察到醛固酮与高血压之间的关联。较高的醛固酮浓度与较低的血清钾和较高的尿钾排泄相关，但仅限于肾素受到抑制时。钠和钾的测量比肾素和醛固酮早几年进行。肾素抑制以及肾素抑制背景下醛固酮浓度升高与患高血压的风险增加相关，也可能与 MR 活性增加相关。这些发现表明正常血压下存在临床相关的亚临床原发性醛固酮增多症（肾素非依赖性醛固酮增多症）。美国国立卫生研究院
Primary aldosteronism is recognized as a severe form of “renin-independent aldosteronism” that results in excessive mineralocorticoid receptor (MR) activation. To investigate whether there is a spectrum of subclinical renin-independent aldosteronism among normotensives that increases risk for hypertension. Cohort study. National community-based study. 850 untreated normotensive participants in the Multi-Ethnic Study of Atherosclerosis with measurements of serum aldosterone, plasma renin activity (PRA). Longitudinal analyses investigated whether aldosterone concentrations, in the context of physiologic PRA phenotypes (suppressed: ≤0.50; indeterminate: 0.51–0.99; unsuppressed: ≥1.0 μg/L/h), associated with incident hypertension, defined as SBP≥140, DBP≥90 mmHg, or initiation of anti-hypertensive medications. Cross-sectional analyses investigated associations of aldosterone with MR activity, assessed via serum potassium and urinary fractional excretion of potassium. A suppressed renin phenotype was associated with a higher rate of incident hypertension when compared to other PRA phenotypes (85.4 [73.4, 99.3] vs. 53.3 [42.8, 66.4] vs. 54.5 [41.8, 71.0] cases per 1000 person-years of follow-up). With renin suppression, higher aldosterone concentrations were independently associated with an increased risk for incident hypertension; whereas no association between aldosterone and hypertension was observed when renin was not suppressed. Higher aldosterone concentrations were associated with lower serum potassium and higher urinary excretion of potassium, but only when renin was suppressed. Measurements of sodium and potassium occurred several years before renin and aldosterone. Suppression of renin, and higher aldosterone concentrations in the context of this renin suppression, associated with an increased risk for developing hypertension and possibly also with increased MR activity. These findings suggest a clinically-relevant spectrum of subclinical primary aldosteronism (renin-independent aldosteronism) in normotension. National Institutes of Health