Chen Shao-xing, Du Yue-ling, Zhang Jin, Gong Yan-chun, Hu Ya-rong, Chu Shao-li, He Qing-bo, Song Yan-yan, Zhu Ding-liang
Department of Hypertension, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2006 Oct;34(10):868-72.
In recent years, the assessment of the plasma aldosterone-to-renin ratio (ARR) has become a most effectively and commonly used method for screening primary aldosteronism from hypertensive patients. It is known that there is a large variance in ARR value between races and ARR is affected by many factors, such as drugs, posture and serum potassium etc. The objective of this study is to establish the threshold of ARR for screening primary aldosteronism in Chinese hypertensive patients.
A total of 110 hypertensive patients were recruited and divided into essential hypertension group (n=65) and adenoma/hyperplasia group (n=45) according to the adrenal contrast CT scan. Antihypertensive drugs which can affect ARR such as beta-blockers, dihydropyridine calcium channel blockers (CCBs), ACE inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) and clonidine, were withdrawn for at least 2 weeks. Washout period for diuretics including spironolactone were 4 weeks. Non-dihydropyridine calcium channel blockers (slow released verapamil) and/or alpha-blocker (terazosin) are allowed for controlling blood pressure when needed. If the serum potassium value<3.6 mmol/L, an oral potassium supplement was prescribed. After keeping upright position for 2 hours, blood samples were drawn for PRA and PAC measurement between 9:00AM-10:00AM.
ARR was 100.00+/-48.65 (14.19-285.16) pg/ml vs ngxml-1xh-1 in patients with essential hypertension and 699.33+/-213.33 (185.8-2150) pg/ml vs ngxml-1xh-1 in patients with adenoma/hyperplasia. ARR value was greater than 240 in 42 out of 45 patients (93.3%) with adenoma/hyperplasia and was less than 240 in 59 out of 65 (90.7%) patients with essential hypertension. We used ARR 240 as the cut-off threshold for screening primary aldosteronism in another 178 hypertensive patients and ARR was greater than 240 in all 15 patients with confirmed primary aldosteronism.
It is suitable to use upright ARR 240 as a cut-off threshold for screening primary aldosteronism in Chinese hypertensive patients.
近年来，血浆醛固酮与肾素比值（ARR）测定已成为从高血压患者中筛查原发性醛固酮增多症最有效且常用的方法。已知不同种族间ARR值存在较大差异，且ARR受多种因素影响，如药物、体位及血钾等。本研究旨在确立中国高血压患者筛查原发性醛固酮增多症的ARR阈值。
共纳入110例高血压患者，根据肾上腺增强CT扫描结果分为原发性高血压组（n = 65）和腺瘤/增生组（n = 45）。停用可能影响ARR的降压药物，如β受体阻滞剂、二氢吡啶类钙通道阻滞剂（CCB）、血管紧张素转换酶抑制剂（ACEI）、血管紧张素Ⅱ受体阻滞剂（ARB）及可乐定，至少停药2周。螺内酯等利尿剂的洗脱期为4周。必要时可使用非二氢吡啶类钙通道阻滞剂（缓释维拉帕米）和/或α受体阻滞剂（特拉唑嗪）控制血压。若血钾值<3.6 mmol/L，则给予口服补钾。保持直立位2小时后，于上午9:00 - 10:00采集血样测定血浆肾素活性（PRA）和醛固酮（PAC）。
原发性高血压患者的ARR为100.00±48.65（14.19 - 285.16）pg/ml·ng⁻¹·h⁻¹，腺瘤/增生组患者的ARR为699.33±213.33（185.8 - 2150）pg/ml·ng⁻¹·h⁻¹。腺瘤/增生组45例患者中42例（93.3%）的ARR值大于240，原发性高血压组65例患者中59例（90.7%）的ARR值小于240。我们将ARR 240作为另178例高血压患者筛查原发性醛固酮增多症的截断阈值，在所有15例确诊为原发性醛固酮增多症的患者中，ARR均大于240。
采用直立位ARR 240作为中国高血压患者筛查原发性醛固酮增多症的截断阈值是合适的。
