Primary aldosteronism and hypertensive disease
Primary aldosteronism and hypertensive disease
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DOI：
10.1161/01.hyp.0000079505.25750.11
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发表时间：
2003-08-01
期刊：
影响因子：
8.3
通讯作者：
Fardella, CE
中科院分区：
文献类型：
--
作者：
Mosso, L;Carvajal, C;Fardella, CE
最近的研究表明，高血压人群中使用的血清醛固酮（SA），血浆肾素活性（PRA）的比值作为筛选试验原发性醛固酮增多症（PA）的患病率很高。该频率高于先前描述的低钾血症用作筛选工具时的频率。然而，其他因素，如高血压疾病的特点，也可能影响PA的患病率。我们研究了609例原发性高血压患者，根据联合国家委员会VI（JNC VI），根据其高血压疾病的严重程度分为3个不同的阶段。我们测量了所有患者的SA和PRA，并计算了SA-PRA比值。609例患者中有63例检测到SA-PRA比值> 25，氟氢可的松试验证实了609例患者中37例（6.1%）的PA诊断。根据高血压分期，PA患病率如下：1期，6/301例（1.99%）; 2期，15/187例（8.02%）; 3期，16/121例（13.2%）。PA患者比其他高血压患者稍年轻（48.4 ± 10.5岁vs 53.6 ± 10.2岁; P < 0.05）。37例PA患者中36例血清钾水平正常，仅1例患者有轻度低钾血症。CT显示双侧肾上腺增大7例，肾上腺结节2例。总之，我们发现根据JNC VI分类为2级和3级的原发性高血压患者中PA的发生率很高。计算机断层扫描异常和低钾血症的低频率表明，大多数PA患者的诊断对应于疾病的衰减形式。
Recent studies in hypertensive populations that have used the serum aldosterone ( SA) to plasma renin activity (PRA) ratio as a screening test have demonstrated a high prevalence of primary aldosteronism (PA). This frequency is higher than that previously described when hypokalemia was used as a screening tool. However, other factors, such as the characteristics of hypertensive disease, could also influence the prevalence of PA. We studied 609 essential hypertensive patients, classified according to the Joint National Committee VI (JNC VI), in 3 different stages depending on the severity of their hypertensive disease. We measured SA and PRA and calculated the SA-PRA ratio for all patients. An SA-PRA ratio > 25 was detected in 63 of 609 patients, and the fludrocortisone test confirmed the PA diagnoses in 37 of 609 ( 6.1%) cases. PA prevalence according to hypertension stage was as follows: stage 1, 6 of 301 cases ( 1.99%); stage 2, 15 of 187 cases (8.02%); and stage 3, 16 of 121 cases (13.2%). PA patients were slightly younger than the other hypertensive patients ( 48.4 +/- 10.5 vs 53.6 +/- 10.2 years; P < 0.05). Serum potassium levels were normal in 36 of 37 PA patients; only 1 patient had minor hypokalemia. Computed tomography scans showed bilateral adrenal enlargement in 7 and an adrenal nodule in 2 cases. In summary, we found a high frequency of PA in essential hypertensives classified in stages 2 and 3 according to the JNC VI. The low frequency of computed tomography scan abnormalities and hypokalemia suggests that the diagnosis for most PA patients corresponds to attenuated forms of the disease.