Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy.
Best Pract Res Clin Endocrinol Metab. 2020 Mar;34(2):101417. doi: 10.1016/j.beem.2020.101417. Epub 2020 Mar 10.
Primary aldosteronism (PA) is a highly prevalent cause of arterial hypertension featuring excess cardiovascular events. A timely diagnosis and treatment of PA cures hyperaldosteronism and can provide resolution or improvement of arterial hypertension, even when the latter is resistant to drug treatment. Accordingly, strategies to screen early and widely the hypertensive patients for PA by means of simplified diagnostic algorithms are justified. Such strategies are particularly beneficial in subgroups of hypertensive patients, who are at the highest cardiovascular risk. Broadening of screening strategies means facing with an increased number of patients where monitoring the disease becomes necessary. Hence, after identification of the surgically and non surgically curable cases of PA and implementation of targeted treatment physicians are faced with the challenges of follow-up, which are scantly discussed in the literature. Hence, the purpose of this paper is to provide some recommendations on how to optimize the monitoring of patients in whom the PA subtype has been diagnosed and treatment, either with unilateral laparoscopic adrenalectomy or medically, has been instituted.
原发性醛固酮增多症（PA）是一种常见的导致动脉高血压的疾病，其特点是心血管事件过多。及时诊断和治疗 PA 可以治愈醛固酮增多症，并能解决或改善动脉高血压，即使后者对药物治疗有抵抗。因此，通过简化诊断算法，对高血压患者进行早期和广泛的 PA 筛查的策略是合理的。这种策略在心血管风险最高的高血压患者亚组中尤其有益。扩大筛查策略意味着需要监测更多的患者，这就需要进行疾病监测。因此，在确定了可通过手术和非手术治疗的 PA 病例并实施了针对性治疗后，医生面临着随访的挑战，而这在文献中讨论甚少。因此，本文的目的是提供一些关于如何优化诊断为 PA 亚型的患者以及接受单侧腹腔镜肾上腺切除术或药物治疗的患者监测的建议。
