Hypertension Unit, Department of Medicine, DIMED, University of Padova, Padova, Italy.
J Am Coll Cardiol. 2019 Dec 3;74(22):2799-2811. doi: 10.1016/j.jacc.2019.09.057.
Primary aldosteronism (PA) is a common, but frequently overlooked, cause of arterial hypertension and excess cardiovascular events, particularly atrial fibrillation. As timely diagnosis and treatment can provide a cure of hyperaldosteronism and hypertension, even when the latter is resistant to drug treatment, strategies to screen patients for PA early with a simplified diagnostic algorithm are justified. They can be particularly beneficial in some subgroups of hypertensive patients, as those who are at highest cardiovascular risk. However, identification of the surgically curable cases of PA and achievement of optimal results require subtyping with adrenal vein sampling, which, as it is technically challenging and currently performed only in tertiary referral centers, represents the bottleneck in the work-up of PA. Measures aimed at improving the clinical use of adrenal vein sampling and at developing alternative techniques for subtyping, alongside recommendations for drug treatment, including new development in the field, and for follow-up are discussed.
原发性醛固酮增多症（PA）是一种常见但常被忽视的动脉高血压和心血管事件（尤其是心房颤动）的病因。由于及时诊断和治疗不仅可以治愈醛固酮增多症和高血压，甚至在后者对药物治疗产生抵抗时也可以，因此采用简化的诊断算法早期筛查 PA 患者的策略是合理的。这些策略在某些高血压患者亚组中特别有益，如心血管风险最高的患者。然而，确定可通过手术治疗的 PA 病例并取得最佳结果需要通过肾上腺静脉取样进行亚型分类，由于该方法具有技术挑战性，并且目前仅在三级转诊中心进行，因此代表了 PA 诊断的瓶颈。本文讨论了旨在提高肾上腺静脉取样临床应用的措施，以及开发替代亚型分类技术的建议，包括该领域的新进展，以及随访建议。
