From the, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Endocrinology, Helsinki University Hospital and Research Programs Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland.
J Intern Med. 2021 Jan;289(1):29-41. doi: 10.1111/joim.13115. Epub 2020 Jun 29.
The diagnostics of primary aldosteronism (PA) are usually carried out in patients taking antihypertensive medications. We compared haemodynamics between medicated PA, medicated essential hypertension (EH), never-medicated EH and normotensive controls (n = 130 in all groups).
The hypertensive groups were matched for age (53 years), sex (84 male/46 female) and body mass index (BMI) (30 kg m ); normotensive controls had similar sex distribution (age 48 years, BMI 27 kg m ). Haemodynamics were recorded using whole-body impedance cardiography and radial pulse wave analysis, and the results were adjusted as appropriate. Radial blood pressure recordings were calibrated by brachial blood pressure measurements from the contralateral arm.
Radial and aortic systolic and diastolic blood pressure was similar in PA and never-medicated EH, and higher than in medicated EH and normotensive controls (P ≤ 0.001 for all comparisons). Extracellular water balance was ~ 4% higher in PA than in all other groups (P < 0.05 for all), whilst cardiac output was ~ 8% higher in PA than in medicated EH (P = 0.012). Systemic vascular resistance and augmentation index were similarly increased in PA and both EH groups when compared with controls. Pulse wave velocity was higher in PA and never-medicated EH than in medicated EH and normotensive controls (P ≤ 0.033 for all comparisons).
Medicated PA patients presented with corresponding systemic vascular resistance and wave reflection, but higher extracellular water volume, cardiac output and arterial stiffness than medicated EH patients. Whether the systematic evaluation of these features would benefit the clinical diagnostics of PA remains to be studied in future.
原发性醛固酮增多症（PA）的诊断通常在服用抗高血压药物的患者中进行。我们比较了服用药物的 PA、服用药物的原发性高血压（EH）、未服用药物的 EH 和血压正常的对照组（各组均为 130 人）之间的血液动力学。
高血压组在年龄（53 岁）、性别（84 名男性/46 名女性）和体重指数（BMI）（30kg/m2）方面与对照组相匹配；血压正常的对照组性别分布相似（年龄 48 岁，BMI 27kg/m2）。使用全身阻抗心动图和桡动脉脉搏波分析记录血液动力学，结果进行适当调整。桡动脉血压记录通过对侧手臂的肱动脉血压测量进行校准。
PA 和未服用药物的 EH 的桡动脉和主动脉收缩压和舒张压与服用药物的 EH 相似，高于血压正常的对照组（所有比较均 P≤0.001）。PA 组细胞外液平衡比所有其他组高约 4%（所有比较均 P<0.05），而 PA 组的心输出量比服用药物的 EH 组高约 8%（P=0.012）。与对照组相比，PA 和两种 EH 组的全身血管阻力和增强指数均增加。PA 和未服用药物的 EH 的脉搏波速度高于服用药物的 EH 和血压正常的对照组（所有比较均 P≤0.033）。
服用药物的 PA 患者表现出相应的全身血管阻力和波反射，但细胞外液体积、心输出量和动脉僵硬程度高于服用药物的 EH 患者。这些特征的系统评估是否会有益于 PA 的临床诊断，有待未来进一步研究。
