University of Texas Southwestern Medical School, Dallas, TX, USA.
J Hypertens. 2012 Oct;30(10):1899-902. doi: 10.1097/HJH.0b013e3283559a03.
Primary aldosteronism is widely held to be the most common cause of identifiable (secondary) hypertension, reported to be present in 6-10% of all hypertensive patients. This belief reflects the widespread use of the aldosterone-to-renin ratio (ARR) as a screening test. Unfortunately, the ARR is often wrong, leading to even more expensive testing that is also often misleading but that may then lead to potentially harmful additional measures. This review provides evidence that referral bias has markedly inflated the estimates of this condition and recommends a much less aggressive approach to the diagnosis of this condition based on more limited testing and the use of mineralocorticoid receptor antagonists in the treatment of most hypertensive patients.
原发性醛固酮增多症被广泛认为是可识别（继发性）高血压最常见的病因，据报道，所有高血压患者中有 6-10%存在这种病症。这种认识反映了醛固酮与肾素比值（ARR）作为筛查试验的广泛应用。不幸的是，ARR 常常是错误的，导致进行更昂贵的检查，而这些检查也常常具有误导性，但可能会导致潜在的有害的额外措施。本综述提供了证据表明转诊偏倚明显夸大了这种病症的估计，并建议基于更有限的检查和在大多数高血压患者中使用盐皮质激素受体拮抗剂，对这种病症的诊断采取一种不那么激进的方法。
