Guidelines for primary aldosteronism: uptake by primary care physicians in Europe
Guidelines for primary aldosteronism: uptake by primary care physicians in Europe
复制标题
DOI：
10.1097/hjh.0000000000001088
复制
发表时间：
2016-11-01
影响因子：
4.9
通讯作者：
Funder, John
中科院分区：
文献类型：
--
作者：
Mulatero, Paolo;Monticone, Silvia;Funder, John
背景：原发性醛固酮增多症是继发性高血压最常见的形式，但仍明显诊断不足。2008年，内分泌学会发布了原发性醛固酮增多症诊断和管理指南；目前的迹象表明这些指南没有得到广泛遵循。
目的：调查意大利和德国大量有代表性的全科医生群体对指南的了解程度和应用情况。
设置与设计：该研究通过关于高血压和原发性醛固酮增多症管理的网络问卷对500名全科医生（意大利250名，德国250名）进行，按地理区域和城市规模分层。
结果：平均接诊患者数量在德国为1747人，在意大利为1388人。其中，在意大利18%被诊断为高血压，在德国为25%。在意大利7%的全科医生会要求进行肾素和醛固酮检测，在德国为8%。意大利的全科医生认为8%的患者符合进行醛固酮和肾素检测的条件，而德国为13%。在意大利，高血压患者中原发性醛固酮增多症的患病率为1%；36%的全科医生表示其诊治的患者中没有原发性醛固酮增多症患者，或之前没有诊断过此类患者。在德国，高血压患者中原发性醛固酮增多症的患病率为2%；19%的全科医生没有原发性醛固酮增多症患者。
结论：在德国和意大利，全科医生没有广泛认识到原发性醛固酮增多症；内分泌学会关于原发性醛固酮增多症诊断的指南不为人熟知或未得到应用，导致该疾病明显诊断不足。
Context:Primary aldosteronism is the most frequent form of secondary hypertension but is still markedly underdiagnosed. In 2008, the Endocrine Society released guidelines for primary aldosteronism diagnosis and management; current indications are that they are not being widely followed.Objective:To investigate the level of knowledge and application of the guidelines in a large representative cohort of general practitioners (GPs) in Italy and Germany.Setting and design:The study was carried out by web questionnaire on hypertension and primary aldosteronism management with 500 GPs (250 in Italy and 250 in Germany), stratified by geographical area and city size.Results:The mean number of patients seen was 1747 (Germany) and 1388 (Italy). Of these, 18% were diagnosed as hypertensive in Italy and 25% in Germany. Renin and aldosterone measurements were ordered by 7% of GPs in Italy and 8% in Germany. GPs in Italy considered 8% of patients eligible for aldosterone and renin measurements compared with 13% of GPs in Germany. In Italy, primary aldosteronism prevalence was 1% among hypertensive patients; 36% of the GPs reported no primary aldosteronism patients under their care or diagnosed previously. In Germany, the prevalence of primary aldosteronism was 2% among hypertensive patients; 19% of GPs had no primary aldosteronism patients.Conclusion:In Germany and in Italy, primary aldosteronism is not widely recognized by GPs; Endocrine Society guidelines for primary aldosteronism diagnosis are not well known or applied, resulting in marked underdiagnosis of the disease.