Mourtzinis Georgios, Ebrahimi Ahmad, Gustafsson Helena, Johannsson Gudmundur, Manhem Karin
Department of Medicine and Emergency, Sahlgrenska University Hospital, Mölndal, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden.
Horm Metab Res. 2017 Nov;49(11):831-837. doi: 10.1055/s-0043-119220. Epub 2017 Sep 21.
Atrial fibrillation seems to be overrepresented among patients with primary aldosteronism. The aim of this study was to determine the usefulness of aldosterone to renin ratio as a screening instrument for primary aldosteronism in an atrial fibrillation population with relatively low cardiovascular risk profile. A total of 149 patients <65 years and with history of AF were screened for primary aldosteronism using aldosterone to renin ratio. Pathologically increased aldosterone to renin ratio (>65 pmol/mIU) was found in 15 participants (10.1%). Further investigation of the positive screened participants and confirmatory saline infusion test resulted in a diagnosis of primary aldosteronism in four individuals out of 149 (2.6%). Three out of the four individuals with primary aldosteronism had previously been diagnosed with hypertension, but only one out of the four had uncontrolled blood pressure, that is, >140/90 mmHg. All participants had normal potassium levels. Individuals with increased aldosterone to renin ratio had significantly higher mean systolic and diastolic blood pressure in comparison to participants with normal aldosterone to renin ratio (136 vs. 126 mmHg, p=0.02 and 84 vs. 78 mmHg, p=0.02). These findings suggest that assessment of aldosterone to renin ratio can be useful for identification of underlying primary aldosteronism in patients with diagnosed atrial fibrillation and hypertension in spite of well controlled blood pressure and normokalemia.
在原发性醛固酮增多症患者中，心房颤动的比例似乎过高。本研究的目的是确定在心血管风险相对较低的心房颤动人群中，醛固酮与肾素比值作为原发性醛固酮增多症筛查工具的有效性。对149名年龄<65岁且有房颤病史的患者使用醛固酮与肾素比值筛查原发性醛固酮增多症。15名参与者（10.1%）的醛固酮与肾素比值病理性升高（>65 pmol/mIU）。对筛查阳性的参与者进行进一步检查并进行盐水输注试验确诊，149名患者中有4人（2.6%）被诊断为原发性醛固酮增多症。4名原发性醛固酮增多症患者中有3人之前被诊断患有高血压，但4人中只有1人血压未得到控制，即>140/90 mmHg。所有参与者的血钾水平均正常。与醛固酮与肾素比值正常的参与者相比，醛固酮与肾素比值升高的参与者的平均收缩压和舒张压显著更高（136 vs. 126 mmHg，p=0.02；84 vs. 78 mmHg，p=0.02）。这些发现表明，尽管血压得到良好控制且血钾正常，但对于已诊断为心房颤动和高血压的患者，评估醛固酮与肾素比值有助于识别潜在的原发性醛固酮增多症。
