Prejbisz A, Warchoł-Celińska E, Lenders J W M, Januszewicz A
Department of Hypertension, Institute of Cardiology, Warsaw, Poland.
Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Horm Metab Res. 2015 Dec;47(13):973-80. doi: 10.1055/s-0035-1565124. Epub 2015 Nov 17.
After the first cases of primary aldosteronism were described and characterized by Conn, a substantial body of experimental and clinical evidence about the long-term effects of excess aldosterone on the cardiovascular system was gathered over the last 5 decades. The prevalence of primary aldosteronism varies considerably between different studies among hypertensive patients, depending on patient selection, the used diagnostic methods, and the severity of hypertension. Prevalence rates vary from 4.6 to 16.6% in those studies in which confirmatory tests to diagnose primary aldosteronism were used. There is also growing evidence indicating that prolonged exposure to elevated aldosterone concentrations is associated with target organ damage in the heart, kidney, and arterial wall, and high cardiovascular risk in patients with primary aldosteronism. Therefore, the aim of treatment should not be confined to BP normalization and hypokalemia correction, but rather should focus on restoring the deleterious effects of excess aldosterone on the cardiovascular system. Current evidence convincingly demonstrates that both surgical and medical treatment strategies beneficially affect cardiovascular outcomes and mortality in the long term. Further studies can be expected to provide better insight into the relationship between cardiovascular risk and complications and the genetic background of primary aldosteronism.
在原发性醛固酮增多症的首批病例被康恩描述并确定其特征之后，在过去50年里积累了大量关于醛固酮过量对心血管系统长期影响的实验和临床证据。在高血压患者中，不同研究之间原发性醛固酮增多症的患病率差异很大，这取决于患者的选择、所使用的诊断方法以及高血压的严重程度。在那些使用确诊试验来诊断原发性醛固酮增多症的研究中，患病率从4.6%到16.6%不等。也有越来越多的证据表明，长期暴露于升高的醛固酮浓度与心脏、肾脏和动脉壁的靶器官损害以及原发性醛固酮增多症患者的高心血管风险有关。因此，治疗的目标不应局限于血压正常化和低钾血症的纠正，而应侧重于恢复醛固酮过量对心血管系统的有害影响。目前的证据令人信服地表明，手术和药物治疗策略从长期来看都对心血管结局和死亡率有有益影响。预计进一步的研究能够更深入地了解心血管风险和并发症之间的关系以及原发性醛固酮增多症的遗传背景。
