Implication of MR Activity in Posttreatment Arterial Stiffness Reversal in Patients With Primary Aldosteronism
Implication of MR Activity in Posttreatment Arterial Stiffness Reversal in Patients With Primary Aldosteronism
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DOI：
10.1210/clinem/dgac649
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发表时间：
2022-11-05
影响因子：
5.8
通讯作者：
Lin, Yen-Hung
中科院分区：
文献类型：
--
作者：
Chen, Zheng-Wei;Pan, Chien-Ting;Lin, Yen-Hung
内容：原发性醛固酮增多症（PA）患者的动脉硬化程度较高，肾上腺切除术后可以逆转。目的：我们旨在比较手术治疗和药物治疗PA患者动脉硬化的逆转情况，并确定有效药物治疗的预测因素。方法：我们前瞻性地招募了445名PA患者，并收集了基线临床特征、生化、血压、治疗前及治疗后12个月测定脉搏波传导速度（PWV）。在盐皮质激素受体拮抗剂（MRA）治疗的患者中，1年后PWV的变化（Δ PWV）和治疗后的肾素活性之间的关系进行了探讨，使用限制性三次样条（RCS）methods.Results：在445例入组的PA患者中，255例接受肾上腺切除术（组1）和190例接受MRA。在RCS模型中，治疗后血浆肾素活性（PRA）1.5 ng/mL/h是最佳临界值。因此，我们将接受MRA治疗的患者分为2组：PRA受抑制的患者（< 1.5 ng/mL/h，第2组）和PRA未受抑制的患者（>= 1.5 ng/mL/h，第3组）。只有第1组和第3组患者治疗后PWV有统计学显著改善（均P< .001），而第2组治疗后无显著改善（P= .151）。在方差分析和事后分析中，第2组的Delta PWV显著低于第1组（P= .007）和第3组（P= .031）。多变量回归分析的MRA治疗的PA患者确定对数转换后治疗PRA，年龄和基线PWV的独立因素与Δ PWV。结论：动脉僵硬度的逆转发现在PA患者接受肾上腺切除术和药物治疗PA患者未抑制PRA。
Context: Primary aldosteronism (PA) patients have a higher degree of arterial stiffness, which can be reversed after adrenalectomy.Objective: We aimed to compare the reversal of arterial stiffness between surgically and medically treated PA patients and to identify the predictors of effective medical treatment.Methods: We prospectively enrolled 445 PA patients and collected data on baseline clinical characteristics, biochemistry, blood pressure, and pulse wave velocity (PWV) before treatment and 12 months after treatment. In the mineralocorticoid receptor antagonist (MRA)-treated patients, the relationship between the change in PWV after 1 year (Delta PWV) and posttreatment renin activity was explored using the restricted cubic spline (RCS) method.Results: Of the 445 enrolled PA patients, 255 received adrenalectomy (group 1) and 190 received MRAs. In the RCS model, posttreatment plasma renin activity (PRA) 1.5 ng/mL/h was the best cutoff value. Therefore, we divided the MRA-treated patients into 2 groups: those with suppressed PRA (< 1.5 ng/mL/h, group 2), and those with unsuppressed PRA (>= 1.5 ng/mL/h, group 3). Only group 1 and group 3 patients had a statistically significant improvement in PWV after treatment (both P< .001), whereas no significant improvement was noted in group 2 after treatment (P= .151). In analysis of variance and post hoc analysis, group 2 had a significantly lower Delta PWV than group 1 (P= .007) and group 3 (P= .031). Multivariable regression analysis of the MRA-treated PA patients identified log-transformed posttreatment PRA, age, and baseline PWV as independent factors correlated with Delta PWV.Conclusion: The reversal of arterial stiffness was found in PA patients receiving adrenalectomy and in medically treated PA patients with unsuppressed PRA.