Rossi Gian Paolo, Ceolotto Giulio, Rossitto Giacomo, Maiolino Giuseppe, Cesari Maurizio, Seccia Teresa Maria
Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
J Clin Endocrinol Metab. 2020 Jun 1;105(6). doi: 10.1210/clinem/dgaa080.
While current guidelines recommend the withdrawal of mineralocorticoid receptor antagonist (MRA) and renin-angiotensin system blockers for the screening and detection of primary aldosteronism (PA), this can worsen hypokalemia and control of high blood pressure (BP) values.
To investigate whether aldosterone/renin ratio (ARR) values were affected by the MRA canrenone and/or by canrenone plus olmesartan treatment in patients with PA.
Within-patient study.
The European Society of Hypertension center of excellence at the University of Padua.
Consecutive patients with an unambiguous diagnosis of PA subtyped by adrenal vein sampling.
Patients were treated for 1 month with canrenone (50-100 mg orally), and for an additional month with canrenone plus olmesartan (10-20 mg orally). Canrenone and olmesartan were up-titrated over the first 2 weeks until BP values and hypokalemia were controlled. Patients with unilateral PA were adrenalectomized; those with bilateral PA were treated medically.
BP, plasma levels of sodium and potassium, renin and aldosterone.
Canrenone neither lowered plasma aldosterone nor increased renin; thus, the high ARR and true positive rate remained unaffected. Addition of the angiotensin type 1 receptor blocker raised renin and slightly lowered aldosterone, which reduced the ARR and increased the false negative rate.
At doses that effectively controlled serum potassium and BP values, canrenone did not preclude an accurate diagnosis in patients with PA. Addition of the angiotensin type 1 receptor blocker olmesartan slightly raised the false negative rate. Hence, MRA did not seem to endanger the accuracy of the diagnosis of PA.
虽然当前指南建议在原发性醛固酮增多症（PA）的筛查和检测中停用盐皮质激素受体拮抗剂（MRA）和肾素 - 血管紧张素系统阻滞剂，但这可能会加重低钾血症并影响高血压（BP）值的控制。
研究在PA患者中，MRA坎利酮和/或坎利酮加奥美沙坦治疗是否会影响醛固酮/肾素比值（ARR）。
患者自身对照研究。
帕多瓦大学欧洲高血压学会卓越中心。
经肾上腺静脉采血明确诊断为PA的连续患者。
患者先接受1个月的坎利酮治疗（口服50 - 100 mg），随后再接受1个月的坎利酮加奥美沙坦治疗（口服10 - 20 mg）。在治疗的前2周逐渐增加坎利酮和奥美沙坦的剂量，直至血压值和低钾血症得到控制。单侧PA患者接受肾上腺切除术；双侧PA患者接受药物治疗。
血压、血浆钠和钾水平、肾素和醛固酮。
坎利酮既未降低血浆醛固酮水平，也未升高肾素水平；因此，高ARR和真阳性率保持不变。添加1型血管紧张素受体阻滞剂可升高肾素水平并轻微降低醛固酮水平，这降低了ARR并增加了假阴性率。
在有效控制血钾和血压值的剂量下，坎利酮不影响PA患者的准确诊断。添加1型血管紧张素受体阻滞剂奥美沙坦会轻微增加假阴性率。因此，MRA似乎不会危及PA诊断的准确性。
