Calhoun David A, Nishizaka Mari K, Zaman Mohammad A, Thakkar Roopal B, Weissmann Paula
Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Ala, USA.
Hypertension. 2002 Dec;40(6):892-6. doi: 10.1161/01.hyp.0000040261.30455.b6.
Recent reports suggesting that the prevalence of primary hyperaldosteronism may be higher than historically thought have relied on an elevated plasma aldosterone concentration/plasma renin activity ratio to either diagnose or identify subjects at high risk of having primary hyperaldosteronism and have not included suppression testing of all evaluated subjects. In this prospective study of 88 consecutive patients referred to a university clinic for resistant hypertension, we determined the 24-hour urinary aldosterone excretion during high dietary salt ingestion, baseline plasma renin activity, and plasma aldosterone in all subjects. Primary hyperaldosteronism was confirmed if plasma renin activity was <1.0 ng/mL per hour and urinary aldosterone was >12 microg/24-hour during high urinary sodium excretion (>200 mEq/24-hour). Eighteen subjects (20%) were confirmed to have primary hyperaldosteronism. The prevalence of hyperaldosteronism was similar in black and white subjects. Of the 14 subjects with confirmed hyperaldosteronism who have been treated with spironolactone, all have manifested a significant reduction in blood pressure. In this population, an elevated plasma aldosterone/plasma renin activity ratio (>20) had a sensitivity of 89% and a specificity of 71% with a corresponding positive predictive value of 44% and a negative predictive value of 96%. These data provide strong evidence that hyperaldosteronism is a common cause of resistant hypertension in black and white subjects. The accuracy of these results is strengthened by having done suppression testing of all evaluated subjects.
最近的报告表明，原发性醛固酮增多症的患病率可能高于以往的认识，这些报告依据血浆醛固酮浓度/血浆肾素活性比值升高来诊断或识别原发性醛固酮增多症的高危人群，且并未对所有评估对象进行抑制试验。在这项针对88例连续转诊至大学诊所治疗顽固性高血压患者的前瞻性研究中，我们测定了所有对象在高盐饮食摄入期间的24小时尿醛固酮排泄量、基线血浆肾素活性和血浆醛固酮水平。如果在高尿钠排泄（>200 mEq/24小时）期间血浆肾素活性<1.0 ng/mL per小时且尿醛固酮>12 μg/24小时，则确诊为原发性醛固酮增多症。18名对象（20%）被确诊患有原发性醛固酮增多症。醛固酮增多症在黑人和白人对象中的患病率相似。在14例已接受螺内酯治疗的确诊醛固酮增多症对象中，所有人的血压均显著降低。在该人群中，血浆醛固酮/血浆肾素活性比值升高（>20）的敏感性为89%，特异性为71%，相应的阳性预测值为44%，阴性预测值为96%。这些数据提供了有力证据，表明醛固酮增多症是黑人和白人顽固性高血压的常见病因。对所有评估对象进行抑制试验增强了这些结果的准确性。
