Murata Masahiko, Kitamura Tetsuhiro, Tamada Daisuke, Mukai Kosuke, Kurebayashi Shogo, Yamamoto Tsunehiko, Hashimoto Kunihiko, Hayashi Reiko D, Kouhara Haruhiko, Takeiri Sachi, Kajimoto Yoshitaka, Nakao Makoto, Hamasaki Toshimitsu, Otsuki Michio, Shimomura Iichiro
aDepartment of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Osaka bDepartment of Internal Medicine, Nishinomiya Municipal Central Hospital, Nishinomiya cDepartment of Internal Medicine, Kansai Rosai Hospital, Amagasaki, Hyogo dDepartment of Internal Medicine of Endocrinology and Metabolism, NTT West Osaka Hospital, Osaka eDepartment of Internal Medicine of Endocrinology and Metabolism, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano fSenrichuo Ekimae Clinic, Toyonaka gNakao Naika Clinic, Osaka hOffice of Biostatistics and Data Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
J Hypertens. 2017 May;35(5):1079-1085. doi: 10.1097/HJH.0000000000001251.
Previous studies showed higher risk of cardiovascular and cerebrovascular (CCV) events in primary aldosteronism compared with essential hypertension, but the patients of these studies were limited to primary aldosteronism patients with high plasma aldosterone concentration (PAC). The introduction of the aldosterone-renin ratio as the screening test for primary aldosteronism led to the recognition of primary aldosteronism patients with normal PAC (nPA). However, there is no information on the risk of primary aldosteronism including nPA.
In this retrospectively and cross-sectional study, the clinical features and CCV event risk of primary aldosteronism at diagnosis including nPA were investigated and compared with essential hypertension. The study included 292 consecutive primary aldosteronism patients and 498 essential hypertension outpatients. All primary aldosteronism patients were diagnosed by autonomous aldosterone secretion using confirmatory tests, and then divided into nPA (n = 130) and primary aldosteronism patients with high PAC (hPA: n = 162) using a PAC cutoff level of less than 443 pmol/l (16 ng/dl), representing the normal upper limit of PAC.
nPA patients were significantly older at diagnosis of primary aldosteronism and at onset of hypertension compared with hPA patients. They had milder hypokalemia and easier-to-control blood pressure. The results suggested that nPA could be considered a mild type of primary aldosteronism but not an early-stage hPA. Moreover, the risk of all CCV events in nPA was significantly lower than that in hPA (odds ratio 0.42, 95% confidence interval 0.18-0.90, P < 0.05) and not significantly higher than that in essential hypertension (odds ratio 0.95, 95% confidence interval 0.43-1.94, P = 0.899).
This study suggests that aggressive diagnostic workout for nPA is less effective to prevent CCV events.
既往研究表明，与原发性高血压相比，原发性醛固酮增多症患者发生心脑血管（CCV）事件的风险更高，但这些研究的患者仅限于血浆醛固酮浓度（PAC）较高的原发性醛固酮增多症患者。醛固酮-肾素比值作为原发性醛固酮增多症的筛查试验，使得人们认识到PAC正常的原发性醛固酮增多症患者（nPA）。然而，关于包括nPA在内的原发性醛固酮增多症风险的信息尚无报道。
在这项回顾性横断面研究中，对诊断时原发性醛固酮增多症（包括nPA）的临床特征和CCV事件风险进行了调查，并与原发性高血压进行了比较。该研究纳入了292例连续的原发性醛固酮增多症患者和498例原发性高血压门诊患者。所有原发性醛固酮增多症患者均通过确诊试验诊断为自主性醛固酮分泌，然后使用低于443 pmol/l（16 ng/dl）的PAC截断值（代表PAC的正常上限）将其分为nPA组（n = 130）和PAC较高的原发性醛固酮增多症患者组（hPA组：n = 162）。
与hPA患者相比，nPA患者在原发性醛固酮增多症诊断时和高血压发病时年龄显著更大。他们的低钾血症较轻，血压更容易控制。结果表明，nPA可被视为原发性醛固酮增多症的一种轻型，但不是早期hPA。此外，nPA中所有CCV事件的风险显著低于hPA（比值比0.42，95%置信区间0.18 - 0.90，P < 0.05），且不显著高于原发性高血压（比值比0.95，95%置信区间0.43 - 1.94，P = 0.899）。
本研究表明，对nPA进行积极的诊断检查对预防CCV事件的效果较差。
