Stewart P M
Department of Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Lancet. 1999 Apr 17;353(9161):1341-7. doi: 10.1016/S0140-6736(98)06102-9.
Hypertension with hypokalaemia and suppression of plasma renin activity is known as mineralocorticoid hypertension. Although mineralocorticoid hypertension accounts for a small number of patients labelled as having "essential" hypertension, it is a potentially reversible cause of high blood pressure. The most common cause of mineralocorticoid hypertension is probably primary aldosteronism; controlled posture studies to measure plasma renin activity and aldosterone concentrations, followed by adrenal imaging, will ensure the differential diagnosis between an aldosterone-producing adenoma and idiopathic adrenal hyperplasia in most cases. Three monogenic forms of mineralocorticoid hypertension have been described: glucocorticoid-suppressible hyperaldosteronism, Liddle's syndrome, and apparent mineralocorticoid excess, which have provided new insights into mineralocorticoid hormone action. Many patients with mineralocorticoid-based hypertension are now known to have normal serum potassium concentrations. Until the true prevalence of primary aldosteronism and monogenic forms of mineralocorticoid hypertension are defined, a high index of suspicion is needed in every hypertensive patient. Hypertensive patients with hypokalaemia, together with those with severe hypertension or a family history of hypertension or stroke, should be screened for mineralocorticoid excess.
伴有低钾血症及血浆肾素活性受抑制的高血压被称为盐皮质激素性高血压。尽管盐皮质激素性高血压在被标记为“原发性”高血压的患者中占少数，但它是高血压的一个潜在可逆转病因。盐皮质激素性高血压最常见的病因可能是原发性醛固酮增多症；通过控制体位研究来测量血浆肾素活性和醛固酮浓度，随后进行肾上腺成像，在大多数情况下可确保对醛固酮瘤和特发性肾上腺增生进行鉴别诊断。已描述了盐皮质激素性高血压的三种单基因形式：糖皮质激素可抑制性醛固酮增多症、利德尔综合征和表观盐皮质激素过多，它们为盐皮质激素作用提供了新的见解。现在已知许多基于盐皮质激素的高血压患者血清钾浓度正常。在原发性醛固酮增多症和盐皮质激素性高血压单基因形式的真正患病率确定之前，每一位高血压患者都需要保持高度怀疑。低钾血症的高血压患者，以及重度高血压患者或有高血压或中风家族史的患者，都应筛查是否存在盐皮质激素过多。
