From the Department of Diabetes, Endocrinology, and Nutrition (Y. Ohno, M.S., N.I.) and Department of Urology (T. Yamasaki, O.O.), Kyoto University, Japan; Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Japan (Y. Takeda); Department of Endocrinology, Metabolism, and Nephrology, Keio University School of Medicine, Tokyo, Japan (I.K., H.I.); Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan (H.U., M.T., M.N.); Department of Endocrinology and Metabolism, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan (T.I.); Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Japan (T. Katabami, Y. Tanaka); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Japan (N.W., Y.S.); Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Japan (T. Yoshimoto, Y. Ogawa); Department of Metabolic Medicine, Kumamoto University, Japan (J.K.); Department of Nephrology and Endocrinology, Faculty of Medicine, The University of Tokyo, Japan (K.T., M.F.); Department of Endocrinology and Diabetes, Okazaki City Hospital, Japan (M.W.); Department of Cardiology, Sanda City Hospital, Japan (Y.M.); Division of Nephrology, Hypertension, and Endocrinology, Nihon University School of Medicine, Tokyo, Japan (H.K.); Department of Endocrinology, Metabolism, Rheumatology, and Nephrology, Oita University, Yufu, Japan (H.S.); Department of Cardiology, Akashi Medical Center, Japan (K.K.); Department of Metabolic Medicine (M.O.) and Department of Geriatric and General Medicine (K.Y.), Osaka University Graduate School of Medicine, Japan; Department of Cardiology, JR Hiroshima Hospital, Japan (Y.F.); Clinical Research Institute, National Hospital Organization Kyusyu Medical Center, Fukuoka, Japan (A.O.); Department of Endocrinology, Tenriyorozu Hospital, Tenri, Japan (S.O.); Department of Internal Medicine, Uwajima City Hospital, Japan (S.M.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Japan (T.F.); Department of Endocrinology and Metabolism, Tottori University Hospital, Japan (S.I.); Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan (T. Yoneda); Division of Nephrology, Hypertension, Endocrinology, and Diabetology/Metabolism, Fukushima Medical University Hospital, Japan (S.H.); Department of Endocrinology and Diabetes Mellitus, Fukuoka University Hospital, Japan (T. Yanase); Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan (T.S.); Kyoto University Health Services, Japan (T. Kawamura); and Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (F.M., Y. Tabara).
Hypertension. 2018 Mar;71(3):530-537. doi: 10.1161/HYPERTENSIONAHA.117.10263. Epub 2018 Jan 22.
There have been several clinical studies examining the factors associated with cardiovascular disease (CVD) in patients with primary aldosteronism (PA); however, their results have left it unclear whether CVD is affected by the plasma aldosterone concentration or hypokalemia. We assessed the PA database established by the multicenter JPAS (Japan Primary Aldosteronism Study) and compared the prevalence of CVD among patients with PA with that among age-, sex-, and blood pressure-matched essential hypertension patients and participants with hypertension in a general population cohort. We also performed binary logistic regression analysis to determine which parameters significantly increased the odds ratio for CVD. Of the 2582 patients with PA studied, the prevalence of CVD, including stroke (cerebral infarction, cerebral hemorrhage, or subarachnoid hemorrhage), ischemic heart disease (myocardial infarction or angina pectoris), and heart failure, was 9.4% (stroke, 7.4%; ischemic heart disease, 2.1%; and heart failure, 0.6%). The prevalence of CVD, especially stroke, was higher among the patients with PA than those with essential hypertension/hypertension. Hypokalemia (K ≤3.5 mEq/L) and the unilateral subtype significantly increased adjusted odds ratios for CVD. Although aldosterone levels were not linearly related to the adjusted odds ratio for CVD, patients with plasma aldosterone concentrations ≥125 pg/mL had significantly higher adjusted odds ratios for CVD than those with plasma aldosterone concentrations <125 pg/mL. Thus, patients with PA seem to be at a higher risk of developing CVD than patients with essential hypertension. Moreover, patients with PA presenting with hypokalemia, the unilateral subtype, or plasma aldosterone concentration ≥125 pg/mL are at a greater risk of CVD and have a greater need for PA-specific treatments than others.
已经有几项临床研究检查了原发性醛固酮增多症（PA）患者中与心血管疾病（CVD）相关的因素；然而，他们的结果尚不清楚 CVD 是否受血浆醛固酮浓度或低钾血症的影响。我们评估了由多中心 JPAS（日本原发性醛固酮增多症研究）建立的 PA 数据库，并比较了 PA 患者、年龄、性别和血压匹配的原发性高血压患者以及一般人群队列中高血压患者的 CVD 患病率。我们还进行了二元逻辑回归分析，以确定哪些参数显著增加 CVD 的比值比。在研究的 2582 例 PA 患者中，包括中风（脑梗死、脑出血或蛛网膜下腔出血）、缺血性心脏病（心肌梗死或心绞痛）和心力衰竭在内的 CVD 患病率为 9.4%（中风，7.4%；缺血性心脏病，2.1%；心力衰竭，0.6%）。PA 患者的 CVD 患病率，尤其是中风，高于原发性高血压/高血压患者。低钾血症（K≤3.5 mEq/L）和单侧亚型显著增加了 CVD 的调整比值比。尽管醛固酮水平与 CVD 的调整比值比无线性关系，但血浆醛固酮浓度≥125 pg/mL 的患者的 CVD 调整比值比显著高于血浆醛固酮浓度<125 pg/mL 的患者。因此，PA 患者似乎比原发性高血压患者发生 CVD 的风险更高。此外，患有低钾血症、单侧亚型或血浆醛固酮浓度≥125 pg/mL 的 PA 患者发生 CVD 的风险更高，比其他患者更需要针对 PA 的特定治疗。
