Berge Constance, Courand Pierre-Yves, Harbaoui Brahim, Paget Vinciane, Khettab Fouad, Bricca Giampiero, Fauvel Jean-Pierre, Lantelme Pierre
aCardiology Department, European Society of Hypertension Excellence Center, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon bGénomique Fonctionnelle de l'Hypertension artérielle, EA 4173, Université Claude Bernard Lyon1, Villeurbanne cHôpital Nord-Ouest, Villefranche sur saône dCardiology Department, Hôpital Nord-Ouest, Villefranche sur saône eNephrology and Hypertension Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France *Constance Berge and Pierre-Yves Courand contributed equally to the writing of this article.
J Hypertens. 2015 Jan;33(1):118-25. doi: 10.1097/HJH.0000000000000367.
Primary aldosteronism could exert a negative feedback on prorenin secretion, of possibly different magnitude, whether it is related to an aldosterone-producing adenoma (APA) or an idiopathic hyperaldosteronism (IHA). The objectives of this study were to evaluate the level of prorenin in three subgroups: APA, IHA, and essential hypertension; and the performance of the aldosterone-to-prorenin ratio (APR) for the diagnosis of an APA.
Seven hundred and forty-six hypertensive patients with a standardized work-up, including a prorenin measurement, were considered. Ninety-six patients without neutral treatment and 38 patients with other forms of secondary hypertension were excluded. APA and IHA were categorized according to computed tomography scan, adrenal venous sampling, pathological analysis and improvement of hypertension after surgery.
Thirty-five patients had a diagnosis of APA, 57 of IHA and 504 of essential hypertension. Prorenin was lower in APA and IHA than in essential hypertension (32.9, 40.4 and 50.3 pg/ml, respectively; P < 0.001). APR was higher in patients with APA and IHA than in those with essential hypertension (24.0, 11.8, and 4.0 pmol/l per pg/ml, respectively; P < 0.001). The APR was more discriminant than the aldosterone-to-renin ratio to identify APA compared to IHA (area under the receiver operating curve at 0.750 and 0.639, respectively; P = 0.04). The optimal cut-off values were 22 pmol/l per pg/ml for APR (sensitivity 57.0%, specificity 93.0%) and 440 pmol/l per pg/ml for aldosterone-to-renin ratio (sensitivity 54.3%, specificity 82.5%).
Primary aldosteronism and particularly its most caricatural form, that is APA, seems associated with a lower level of prorenin than essential hypertension. The APR could be included in the diagnostic strategy of APA.
原发性醛固酮增多症可能对肾素原分泌产生负反馈，其程度可能不同，无论其与醛固酮瘤（APA）还是特发性醛固酮增多症（IHA）相关。本研究的目的是评估三个亚组（APA、IHA和原发性高血压）中的肾素原水平；以及醛固酮与肾素原比值（APR）对APA诊断的效能。
纳入746例经过标准化检查（包括测量肾素原）的高血压患者。排除96例未接受中性治疗的患者和38例患有其他形式继发性高血压的患者。根据计算机断层扫描、肾上腺静脉采血、病理分析以及术后高血压改善情况对APA和IHA进行分类。
35例患者诊断为APA，57例为IHA，504例为原发性高血压。APA和IHA患者的肾素原水平低于原发性高血压患者（分别为32.9、40.4和50.3 pg/ml；P<0.001）。APA和IHA患者的APR高于原发性高血压患者（分别为24.0、11.8和4.0 pmol/l per pg/ml；P<0.001）。与IHA相比，APR在鉴别APA方面比醛固酮与肾素比值更具判别力（受试者操作特征曲线下面积分别为0.750和0.639；P=0.04）。APR的最佳截断值为22 pmol/l per pg/ml（敏感性57.0%，特异性93.0%），醛固酮与肾素比值的最佳截断值为440 pmol/l per pg/ml（敏感性54.3%，特异性82.5%）。
原发性醛固酮增多症，尤其是其最典型的形式即APA，似乎与比原发性高血压更低的肾素原水平相关。APR可纳入APA的诊断策略中。
