Rossi Gian Paolo, Bernini Giampaolo, Desideri Giovambattista, Fabris Bruno, Ferri Claudio, Giacchetti Gilberta, Letizia Claudio, Maccario Mauro, Mannelli Massimo, Matterello Mee-Jung, Montemurro Domenico, Palumbo Gaetana, Rizzoni Damiano, Rossi Ermanno, Pessina Achille Cesare, Mantero Franco
Department of Clinical and Experimental Medicine, Clinica Medica 4, University Hospital, via Giustiniani, 2, 35126 Padova, Italy.
Hypertension. 2006 Aug;48(2):232-8. doi: 10.1161/01.HYP.0000230444.01215.6a. Epub 2006 Jun 26.
Primary aldosteronism (PA) has been associated with cardiovascular hypertrophy and fibrosis, in part independent of the blood pressure level, but deleterious effects on the kidneys are less clear. Likewise, it remains unknown if the kidney can be diversely involved in PA caused by aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). Hence, in the Primary Aldosteronism Prevalence in Italy (PAPY) Study, a prospective survey of newly diagnosed consecutive patients referred to hypertension centers nationwide, we sought signs of renal damage in patients with PA and in comparable patients with primary hypertension (PH). Patients (n = 1180) underwent a predefined screening protocol followed by tests for confirming PA and identifying the underlying adrenocortical pathology. Renal damage was assessed by 24-hour urine albumin excretion (UAE) rate and glomerular filtration rate (GFR). UAE rate was measured in 490 patients; all had a normal GFR. Of them, 31 (6.4%) had APA, 33 (6.7%) had IHA, and the rest (86.9%) had PH. UAE rate was predicted (P < 0.001) by body mass index, age, urinary Na+ excretion, serum K+, and mean blood pressure. Covariate-adjusted UAE rate was significantly higher in APA and IHA than in PH patients; there were more patients with microalbuminuria in the APA and IHA than in the PH group (P = 0.007). Among the hypertensive patients with a preserved GFR, those with APA or IHA have a higher UAE rate than comparable PH patients. Thus, hypertension because of excess autonomous aldosterone secretion features an early and more prominent renal damage than PH.
原发性醛固酮增多症（PA）与心血管肥大和纤维化有关，部分独立于血压水平，但对肾脏的有害影响尚不清楚。同样，由醛固酮瘤（APA）和特发性醛固酮增多症（IHA）引起的PA中，肾脏是否会有不同程度的受累仍不清楚。因此，在意大利原发性醛固酮增多症患病率（PAPY）研究中，我们对全国高血压中心新诊断的连续患者进行了一项前瞻性调查，以寻找PA患者和原发性高血压（PH）对照患者的肾损伤迹象。1180例患者接受了预先定义的筛查方案，随后进行了确认PA和识别潜在肾上腺皮质病理的检查。通过24小时尿白蛋白排泄率（UAE）和肾小球滤过率（GFR）评估肾损伤。在490例患者中测量了UAE率；所有患者的GFR均正常。其中，31例（6.4%）患有APA，33例（6.7%）患有IHA，其余（86.9%）患有PH。UAE率可由体重指数、年龄、尿钠排泄、血钾和平均血压预测（P<0.001）。协变量调整后的UAE率在APA和IHA患者中显著高于PH患者；APA和IHA患者中微量白蛋白尿患者多于PH组（P=0.007）。在GFR正常的高血压患者中（GFR正常），APA或IHA患者的UAE率高于对照PH患者。因此，由于自主性醛固酮分泌过多引起的高血压，比PH具有更早、更明显的肾损伤。
