Mineralocorticoid Receptor Antagonists Decrease the Rates of Positive Screening for Primary Aldosteronism.
Mineralocorticoid Receptor Antagonists Decrease the Rates of Positive Screening for Primary Aldosteronism.
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DOI：
10.4158/ep-2020-0277
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发表时间：
2020-12
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影响因子：
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通讯作者：
Turcu AF
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文献类型：
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作者：
Tezuka Y;Turcu AF
盐皮质激素受体拮抗剂(MRAs)对顽固性高血压和/或原发性醛固酮增多症(PA)患者有效。理想情况下，PA筛查应在停用可能干扰肾素-血管紧张素-醛固酮系统的药物后进行，但对于顽固性高血压或低钾血症患者来说，这是具有挑战性的。在此，我们的目的是评估MRAS在临床实践中对PA筛查的影响。我们对高血压患者进行了一项回顾性队列研究，这些患者在第三转诊中心使用MRA前后进行了19年的血浆醛固酮和肾素测定。总共有146名患者，其中91名患有PA，并进行了长达18个月的随访。总体而言，MRA开始后，血浆肾素和醛固酮均升高(中位数，四分位数范围分别为：0.5[0.1，0.8]至1.2[0.6，4.8]ng/mL/小时，从19.1[12.9，27.7]至26.4[17.1，42.3]ng/dL；而醛固酮/肾素比值(ARR)从40.3(18.5,102.7)降至23.1(8.6，58.7)ng/dL/ng/m L/h(P<；.0001)。与MRA治疗持续时间和使用的其他降压药无关，也会发生类似的变化。45/94例(48%)患者在MRA检查后PA筛查阳性。相反，17%的患者只有在接受MRA治疗后才有阳性的PA筛查，主要是因为纠正了低钾血症。最初阳性的筛查试验更有可能被高剂量的MRA改变，更有可能在确诊为PA或服用β-受体阻滞剂的患者中持续存在。MRA通常会降低ARR和PA筛查阳性结果的比例。当怀疑为PA时，应重复进行MRAS筛查。
Mineralocorticoid receptor antagonists (MRAs) are effective in patients with resistant hypertension and/or primary aldosteronism (PA). Screening for PA should ideally be conducted after stopping medications that might interfere with the renin-angiotensin-aldosterone system, but this is challenging in patients with recalcitrant hypertension or hypokalemia. Herein, we aimed to evaluate the impact of MRAs on PA screening in clinical practice. We conducted a retrospective cohort study of patients with hypertension who had plasma aldosterone and renin measurements before and after MRA use in a tertiary referral center, over 19 years. A total of 146 patients, 91 with PA, were included and followed for up to 18 months. Overall, both plasma renin and aldosterone increased after MRA initiation (from median, interquartile range: 0.5 [0.1, 0.8] to 1.2 [0.6, 4.8] ng/mL/hour and from 19.1 [12.9, 27.7] to 26.4 [17.1, 42.3] ng/dL, respectively; P<.0001 for both), while the aldosterone/renin ratio (ARR) decreased from 40.3 (18.5, 102.7) to 23.1 (8.6, 58.7) ng/dL per ng/mL/hour (P<.0001). Similar changes occurred irrespective of the MRA treatment duration and other antihypertensives used. Positive PA screening abrogation after MRA initiation was found in 45/94 (48%) patients. Conversely, 17% of patients had positive PA screening only after MRA treatment, mostly due to correction of hypokalemia. An initially positive screening test was more likely altered by high MRA doses and more likely persistent in patients with confirmed PA or taking beta-blockers. MRAs commonly reduce ARR and the proportion of positive PA screening results. When PA is suspected, screening should be repeated off MRAs.