Rayner B L, Myers J E, Opie L H, Trinder Y A, Davidson J S
Hypertension Clinic, Groote Schuur Hospital and University of Cape Town.
S Afr Med J. 2001 Jul;91(7):594-9.
To establish normal ranges for plasma aldosterone, renin and aldosterone/renin (A/R) ratio in South African normotensives under typical outpatient conditions, and to estimate the prevalence of primary aldosteronism (PA) among hypertensives in primary care settings.
One hundred and thirty-six normotensive subjects and 154 sex- and age-matched hypertensives at three primary care clinics had measurements of blood pressure, plasma creatinine, K+, aldosterone, plasma renin activity, and spot urine for urinary Na+/creatinine ratio. Medication was not withdrawn before testing.
Mean plasma renin activity in black normotensive subjects (0.95 +/- 1.25 ng/ml/h, mean +/- standard deviation (SD)) was significantly lower than in white (2.09 +/- 1.12 ng/ml/h; P < 0.0001) and coloured (1.81 +/- 1.86 ng/ml/h, P = 0.013) normotensives. Mean plasma aldosterone in black normotensives (306 +/- 147 pmol/l) was also significantly lower than in white (506 +/- 324 pmol/l, P = 0.0002) and coloured (418 +/- 304 pmol/l, P = 0.0148) normotensives. In hypertensives, there were no significant differences in renin or aldosterone levels between the three population groups. Urinary Na+/creatinine ratios, an index of Na+ intake, were not significantly different in the three population groups. None of the normotensives had an A/R ratio > or = 1,000 plus aldosterone > or = 750, while 7.1% of hypertensives exceeded these levels, suggesting that they are appropriate criteria for screening for PA.
A large fraction of black normotensive subjects had low renin and aldosterone levels compared with whites, suggesting a salt-retaining tendency in black subjects. These results have important implications for the interpretation of plasma renin and aldosterone levels in hypertensive patients. In primary care settings, 7.1% of hypertensives had biochemical results indicating the need for investigation of PA.
在典型门诊条件下，确定南非血压正常者的血浆醛固酮、肾素及醛固酮/肾素（A/R）比值的正常范围，并评估基层医疗环境中高血压患者原发性醛固酮增多症（PA）的患病率。
在三家基层医疗诊所，对136名血压正常者以及154名性别和年龄匹配的高血压患者进行了血压、血浆肌酐、血钾、醛固酮、血浆肾素活性测量，并采集随机尿检测尿钠/肌酐比值。检测前未停用药物。
黑人血压正常者的平均血浆肾素活性（0.95±1.25 ng/ml/h，均值±标准差[SD]）显著低于白人（2.09±1.12 ng/ml/h；P<0.0001）和有色人种（1.81±1.86 ng/ml/h，P = 0.013）血压正常者。黑人血压正常者的平均血浆醛固酮（306±147 pmol/l）也显著低于白人（506±324 pmol/l，P = 0.0002）和有色人种（418±304 pmol/l，P = 0.0148）血压正常者。在高血压患者中，三个群体的肾素或醛固酮水平无显著差异。尿钠/肌酐比值作为钠摄入指标，在三个群体中无显著差异。血压正常者中无A/R比值≥1000且醛固酮≥750者，而7.1%的高血压患者超过这些水平，提示这些标准适用于PA筛查。
与白人相比，很大一部分黑人血压正常者的肾素和醛固酮水平较低，提示黑人有保钠倾向。这些结果对高血压患者血浆肾素和醛固酮水平的解读具有重要意义。在基层医疗环境中，7.1%的高血压患者生化检查结果提示需要对PA进行评估。
