Real-World Effectiveness of Mineralocorticoid Receptor Antagonists in Primary Aldosteronism.
Real-World Effectiveness of Mineralocorticoid Receptor Antagonists in Primary Aldosteronism.
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DOI：
10.3389/fendo.2021.625457
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发表时间：
2021
影响因子：
5.2
通讯作者：
Turcu AF
中科院分区：
文献类型：
--
作者：
Tezuka Y;Turcu AF
目的：研究在使用盐皮质激素受体拮抗剂(MRAs)治疗的原发性醛固酮增多症(PA)和其他低肾素高血压(LRH)患者中，目标肾素被追求和实现的频率如何，因为逆转肾素抑制被证明可以避免这些患者心血管和肾脏发病率和死亡率的增加。我们对2000年1月1日至2020年5月31日期间在学术门诊接受MRAS治疗的PA和LRH患者进行了一项回顾性队列研究。在接受MRAS治疗的30777名高血压患者中，只有7.3%的人被评估为PA。163例(123例PA)在MRA开始后复查肾素。经过中位数124天的随访，70名患者(43%)在最后一次就诊时不再有肾素抑制。LRH组达到目标肾素的比例高于PA组(53%比40%)。较低的基线血钾、较低的MRA剂量和使用β-受体阻滞剂独立地与PA中达到目标肾素的几率较低相关，而男性与LRH中的目标肾素相关。总体而言，50名患者(30.7%)有55例不良事件，均由螺内酯引起，26名患者(52%)改用依普利酮或减少螺内酯剂量。尽管有证据表明，逆转肾素抑制可以为PA和LRH患者提供心肾保护，但很少有患者遵循肾素目标，在学术环境中看到的此类患者中，只有不到一半的患者实现了肾素目标，而在社区实践中，这一比例可能更低。
To investigate how often target renin is pursued and achieved in patients with primary aldosteronism (PA) and other low renin hypertension (LRH) treated with mineralocorticoid receptor antagonists (MRAs), as reversal of renin suppression was shown to circumvent the enhanced cardiovascular and renal morbidity and mortality in these patients. We conducted a retrospective cohort study of patients with PA and LRH treated with MRAs in an academic outpatient practice from January 1, 2000, through May 31, 2020. Of 30,777 patients with hypertension treated with MRAs, only 7.3% were evaluated for PA. 163 patients (123 with PA) had renin followed after MRA initiation. After a median follow-up of 124 [interquartile range, 65-335] days, 70 patients (43%) no longer had renin suppression at the last visit. The proportion of those who achieved target renin was higher in LRH than in PA (53% vs. 40%). Lower baseline serum potassium, lower MRA doses, and beta-blocker use were independently associated with lower odds of achieving target renin in PA, while male sex was associated with target renin in LRH. Overall, 50 patients (30.7%) had 55 adverse events, all from spironolactone, and 26 patients (52%) were switched to eplerenone or had a spironolactone dose reduction. Despite evidence that reversal of renin suppression confers cardio-renal protection in patients with PA and LRH, renin targets are followed in very few and are achieved in under half of such patients seen in an academic setting, with possibly even lower rates in community practices.
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影响因子：
8.3
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