Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study.
Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study.
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DOI：
10.1016/s2213-8587(17)30367-4
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发表时间：
2018-01
期刊：
影响因子：
--
通讯作者：
Vaidya A
中科院分区：
文献类型：
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作者：
Hundemer GL;Curhan GC;Yozamp N;Wang M;Vaidya A
盐皮质激素受体拮抗剂（MRA）是原发性醛固酮增多症（PA）的推荐药物治疗。这一建议是否能有效降低心血管风险尚不清楚。我们进行了一项队列研究，纳入了 602 名接受 MRA 治疗的 PA 患者和 41853 名年龄匹配的原发性高血压 (EH) 患者，以调查与 EH 患者相比，PA 患者发生心血管事件（心肌梗塞、心力衰竭住院、中风的综合）、心房颤动、糖尿病和死亡的风险。在整个研究过程中，两组的心血管风险状况和血压具有相当的相似性。与 EH 相比，接受 MRA 的 PA 患者心血管事件发生率较高：每 1,000 人年分别有 56·3 (48·8, 64·7) 例和 26·6 (26·1, 27·2) 例事件（调整后 HR=1·91 [1·63, 2·25]；调整后 10 年累积发生率差异：14·1 [10·1, 18·0] 超出）每 100 人的事件）。 PA 患者的事件死亡率 (HR=1·34 [1·06, 1·71])、糖尿病 (HR=1·26 [1·01, 1·57]) 和心房颤动 (HR=1·93 [1·54, 2·42]) 的调整后风险也较高。与 EH 相比，心血管事件和死亡率的超额风险仅限于 MRA 肾素活性仍受抑制 (<1 µg/L/h) 的 PA 患者（调整后 HR 分别为 2·83 [2·11, 3·80] 和 1·79 [1·14, 2·80]），而接受较高 MRA 剂量且肾素未抑制 (≥1 µg/L/h) 的患者没有显着的超额风险。目前，MRA 治疗 PA 的实践与心血管代谢事件和死亡风险显着升高相关，与血压控制无关。以 MRA 治疗来提高肾素水平可能会减轻这种过度风险。美国国立卫生研究院
Mineralocorticoid receptor antagonists (MRAs) are the recommended medical therapy for primary aldosteronism (PA). Whether this recommendation effectively reduces cardiovascular risk is not well understood. We conducted a cohort study including 602 PA patients treated with MRAs and 41853 age-matched patients with essential hypertension (EH) to investigate the risk for incident cardiovascular events (composite of myocardial infarction, heart failure hospitalization, stroke), atrial fibrillation, diabetes, and death in patients with PA compared with EH. Both groups had comparable cardiovascular risk profiles and blood pressures throughout the study. The incidence rate of cardiovascular events was higher among PA patients on MRAs compared with EH: 56·3 (48·8, 64·7) versus 26·6 (26·1, 27·2) events per 1,000 person-years (adjusted HR=1·91 [1·63, 2·25]; adjusted 10-year cumulative incidence difference: 14·1 [10·1, 18·0] excess events per 100 persons). PA patients also had higher adjusted risks for incident mortality (HR=1·34 [1·06, 1·71]), diabetes (HR=1·26 [1·01, 1·57]), and atrial fibrillation (HR=1·93 [1·54, 2·42]). Compared with EH, the excess risk for cardiovascular events and mortality was limited to PA patients whose renin activity remained suppressed (<1 µg/L/h) on MRAs (adjusted HR=2·83 [2·11, 3·80] and 1·79 [1·14, 2·80] respectively) whereas patients who were treated with higher MRA doses and had unsuppressed renin (≥1 µg/L/h) had no significant excess risk. Current practice of MRA therapy in PA is associated with significantly higher risk for incident cardiometabolic events and death independent of blood pressure control. Targeting MRA therapy to raise renin may mitigate this excess risk. National Institutes of Health