Endocrinology, Diabetes and Metabolism.
Clinical Biochemistry Laboratory.
J Hypertens. 2020 Sep;38(9):1841-1848. doi: 10.1097/HJH.0000000000002441.
To assess the prevalence of primary aldosteronism and its association with cardiometabolic complications in patients with resistant and refractory hypertension.
One hundred and ten consecutive patients with true resistant hypertension [insufficient blood pressure control despite appropriate lifestyle measures and treatment with at least three classes of antihypertensive medication, including a diuretic] and without previous cardiovascular events were screened for secondary hypertension. Refractory hypertension was diagnosed in case of uncontrolled blood pressure despite the use of at least five antihypertensive drugs.
Primary aldosteronism was diagnosed in 32 cases (29.1%). The multivariate analysis showed that primary aldosteronism is a strong factor positively associated with left ventricular hypertrophy [odds ratio (OR) = 12.98, 95% confidence interval (CI) 3.82-60.88; P < 0.001], microalbuminuria (OR = 3.67, 95% CI 1.44-9.78; P = 0.007), carotid intima-media thickness at least 0.9 mm (OR = 2.69, 95% CI 1.02-7.82; P = 0.037), aortic ectasia (OR = 4.08, 95% CI 1,18-15.04; P = 0.027) and atrial fibrillation (OR 8.80, 95% CI 1.53-73.98; P = 0.022). Moreover, primary aldosteronism was independently associated with the presence of at least one (OR = 8.60, 95% CI 1.73-69.88; P = 0.018) and at least two types of organ damage (OR = 3.08, 95% CI 1.19-8.24; P = 0.022). Thirteen patients (11.8%) were affected by refractory hypertension. This group was characterized by significantly higher values of carotid intima-media thickness, higher rate of aldosterone-producing adenoma and atrial fibrillation, compared with the other individuals with resistant hypertension.
The current study indicates that primary aldosteronism is a frequent cause of secondary hypertension and cardiovascular complications among patients with resistant and refractory hypertension, suggesting a crucial role of aldosterone in the pathogenesis of severe hypertensive phenotypes and cardiovascular disease.
评估原发性醛固酮增多症在难治性和耐药性高血压患者中的患病率及其与心脏代谢并发症的关系。
连续筛选 110 例真性难治性高血压患者（尽管采用了适当的生活方式措施和至少三种降压药物治疗，包括利尿剂，但血压控制仍不理想），以排除继发性高血压。在使用至少五种降压药物仍无法控制血压的情况下，诊断为耐药性高血压。
32 例（29.1%）诊断为原发性醛固酮增多症。多变量分析表明，原发性醛固酮增多症是左心室肥厚的一个重要正相关因素[比值比（OR）=12.98，95%置信区间（CI）3.82-60.88；P<0.001]、微量白蛋白尿（OR=3.67，95%CI 1.44-9.78；P=0.007）、颈动脉内膜中层厚度至少 0.9mm（OR=2.69，95%CI 1.02-7.82；P=0.037）、主动脉扩张（OR=4.08，95%CI 1.18-15.04；P=0.027）和心房颤动（OR=8.80，95%CI 1.53-73.98；P=0.022）。此外，原发性醛固酮增多症与至少一种（OR=8.60，95%CI 1.73-69.88；P=0.018）和至少两种类型的器官损伤（OR=3.08，95%CI 1.19-8.24；P=0.022）的存在独立相关。13 例（11.8%）患者患有耐药性高血压。与其他难治性高血压患者相比，该组患者的颈动脉内膜中层厚度值显著更高，醛固酮分泌性腺瘤的发生率和心房颤动的发生率更高。
目前的研究表明，原发性醛固酮增多症是难治性和耐药性高血压患者继发性高血压和心血管并发症的常见原因，提示醛固酮在严重高血压表型和心血管疾病的发病机制中起着关键作用。
