Widimský Jiří, Bruthans Jan, Wohlfahrt Peter, Krajčoviechová Alena, Šulc Pavel, Linhart Aleš, Filipovský Jan, Lánská Věra, Cífkova Renata
Department of Medicine III, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
Center for Cardiovascular Prevention, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
Blood Press. 2020 Jun;29(3):191-198. doi: 10.1080/08037051.2020.1723406. Epub 2020 Feb 8.
Primary aldosteronism (PA) is considered the most common form of secondary hypertension, however, its prevalence, particularly in a general population, is still a matter of debate. The aim of our study was to evaluate the prevalence of PA in a randomly selected general population sample. A total of 1940 individuals (1% population random sample) aged 25-64 years were screened for major cardiovascular risk factors in six districts of the Czech Republic. Hypertension was defined as a mean of two blood pressure readings ≥140/90 mmHg at one visit or taking antihypertensive medication. Within this population, 740 individuals were labelled as hypertensives and 650 of them sampled for the analysis of direct plasma renin and serum aldosterone. The diagnosis of PA was based on elevated serum aldosterone, low plasma renin and high aldosterone/renin (ARR) ratio and was also verified by a confirmatory test with saline infusion. Positive ARR was found in 52 (8%) individuals (64% women, 36% men, however, due to substatntial proportion of reluctatnt participants to undergo a further work-up (27%), we could confirm the diagnosis of PA only in 13 of them (2%). Aldosterone-producing adenoma was found in one case only, seven patients had idiopathic type and five individuals refused potential surgical treatment therefore, adrenal venous sampling was not performed. Elevated serum aldosterone together with low renin and high ARR were found in 52 (8%) of hypertensives selected from a general population sample, however, the diagnosis of PA was confirmed only in 13 of them (2%). This study based on a general population survey highlighted the difficulty of conducting epidemiological studies on primary aldosteronism in a relatively healthy cohort part of whom did not provide the level of collaboration that is necessary to assess the true prevalence of this condition.
原发性醛固酮增多症（PA）被认为是继发性高血压最常见的形式，然而，其患病率，尤其是在普通人群中的患病率，仍存在争议。我们研究的目的是评估在随机选取的普通人群样本中PA的患病率。在捷克共和国的六个地区，对总共1940名年龄在25 - 64岁的个体（占总人口的1%随机样本）进行了主要心血管危险因素筛查。高血压定义为一次就诊时两次血压读数的平均值≥140/90 mmHg或正在服用抗高血压药物。在这一人群中，740人被标记为高血压患者，其中650人被抽取样本用于分析直接血浆肾素和血清醛固酮。PA的诊断基于血清醛固酮升高、血浆肾素降低以及醛固酮/肾素（ARR）比值升高，并且还通过盐水输注的确诊试验进行了验证。在52名（8%）个体中发现ARR阳性（64%为女性，36%为男性），然而，由于相当一部分参与者不愿接受进一步检查（27%），我们仅能在其中13人（2%）中确诊PA。仅在1例中发现醛固酮瘤，7例患者为特发性类型，5人拒绝潜在的手术治疗，因此未进行肾上腺静脉采样。在从普通人群样本中选取的52名（8%）高血压患者中发现血清醛固酮升高、肾素降低以及ARR升高，然而，仅在其中13人（2%）中确诊PA。这项基于普通人群调查的研究凸显了在相对健康的队列中进行原发性醛固酮增多症流行病学研究的困难，部分人群未提供评估该疾病真实患病率所需的合作水平。
