Giacchetti Gilberta, Turchi Federica, Boscaro Marco, Ronconi Vanessa
Division of Endocrinology, Azienda Ospedaliero-Universtaria, Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Via Conca 71, 60020 Torrette, Ancona, Italy.
Curr Vasc Pharmacol. 2009 Apr;7(2):244-49. doi: 10.2174/157016109787455716.
Primary aldosteronism is the most common cause of secondary hypertension, accounting for about 10% of all forms of high blood pressure. Life-time pharmacological therapy is the treatment of choice for primary aldosteronism due to idiopathic adrenal hyperplasia (IHA), while adrenalectomy is effective in curing most patients with an aldosterone producing adenoma (APA). Far from being a benign form of hypertension, primary aldosteronism is characterized by the development of cardiovascular renal and metabolic complications, including left ventricular hypertrophy, myocardial infarction, atrial fibrillation and stroke, microalbuminuria, renal cysts as well as metabolic syndrome, glucose impairment and diabetes mellitus. We review recent clinical experience with the above mentioned complications and long-term outcomes of blood pressure normalization and cardiac, renal and gluco-metabolic complications in patients with primary aldosteronism, after medical treatment with mineralocorticoid receptor antagonists and surgical treatment. We conclude that removal of adrenal adenoma results in normalization of the renin-angiotensin-aldosterone system (RAAS) and of kalaemia and improvement of blood pressure levels in all patients. Complete resolution of hypertension is achieved in nearly half of treated patients. Moreover, unilateral adrenalectomy is the best treatment to have the regression of cardiovascular, renal and metabolic complications in patients with APA. On the other hand, targeted medical treatment with aldosterone antagonists improves blood pressure control and appears able to prevent the progression of cardiac and metabolic complications in patients with IHA.
原发性醛固酮增多症是继发性高血压最常见的病因，约占所有高血压类型的10%。对于特发性肾上腺增生（IHA）所致的原发性醛固酮增多症，终身药物治疗是首选治疗方法，而肾上腺切除术对大多数醛固酮分泌腺瘤（APA）患者有效。原发性醛固酮增多症绝非一种良性高血压形式，其特征是会出现心血管、肾脏和代谢并发症，包括左心室肥厚、心肌梗死、心房颤动和中风、微量白蛋白尿、肾囊肿以及代谢综合征、糖代谢受损和糖尿病。我们回顾了原发性醛固酮增多症患者在接受盐皮质激素受体拮抗剂药物治疗和手术治疗后，上述并发症的近期临床经验以及血压正常化和心脏、肾脏及糖代谢并发症的长期转归。我们得出结论，切除肾上腺腺瘤可使肾素 - 血管紧张素 - 醛固酮系统（RAAS）和血钾正常化，并改善所有患者的血压水平。近一半接受治疗的患者实现了高血压的完全缓解。此外，单侧肾上腺切除术是使APA患者的心血管、肾脏和代谢并发症消退的最佳治疗方法。另一方面，使用醛固酮拮抗剂进行靶向药物治疗可改善血压控制，并似乎能够预防IHA患者心脏和代谢并发症的进展。
