Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia.
Department of Endocrinology, Monash Health, Clayton, Vic, Australia.
Clin Endocrinol (Oxf). 2021 Mar;94(3):353-360. doi: 10.1111/cen.14373. Epub 2020 Dec 3.
Primary aldosteronism (PA) is a potentially curable cause of hypertension associated with worse cardiovascular prognosis than blood pressure-matched essential hypertension (EH). Effective targeted treatment for PA is available with the greatest benefit seen if treatment is started early, prior to the development of end-organ damage. However, PA is currently substantially under-diagnosed. The standard screening test for PA, the aldosterone-to-renin ratio (ARR), is performed infrequently in both primary and tertiary care. In contrast, ambulatory blood pressure monitoring (ABPM) is frequently utilized in the assessment of hypertension. The aim of this study was to compare ABPM parameters in hypertensive patients with and without PA, in order to identify features of ABPM associated with PA that can prompt screening.
Patients with PA (n = 55) were identified from a tertiary clinic specializing in the management of endocrine causes of hypertension whilst the controls (n = 389) were consecutive patients with hypertension but without a known diagnosis of PA who were referred for ABPM.
In this study, PA patients were younger and had higher 24-h, day, and night-time blood pressure compared with controls despite similar number of antihypertensive medications. However, there was no significant difference in nocturnal dipping or day-night blood pressure variability between the two groups.
An elevated ambulatory blood pressure in patients on multiple antihypertensives could suggest underlying PA but in the absence of other distinguishing features, ABPM could not reliably differentiate PA from other forms of hypertension. Routine biochemical screening for PA remained the most reliable way of detecting this treatable secondary cause of hypertension.
原醛症（PA）是一种潜在可治愈的高血压病因，其心血管预后比血压匹配的原发性高血压（EH）更差。PA 有有效的靶向治疗方法，如果在发生终末器官损伤之前尽早开始治疗，获益最大。然而，PA 目前的诊断率明显不足。PA 的标准筛查试验，即醛固酮与肾素比值（ARR），在初级和三级保健中都很少进行。相比之下，动态血压监测（ABPM）常用于高血压的评估。本研究旨在比较有和无 PA 的高血压患者的 ABPM 参数，以确定与 PA 相关的可提示筛查的 ABPM 特征。
从专门治疗内分泌性高血压的三级诊所中确定了 55 例 PA 患者（n=55），而对照组（n=389）则为连续就诊的高血压但无已知 PA 诊断的患者，他们被转诊进行 ABPM。
在这项研究中，PA 患者比对照组更年轻，24 小时、白天和夜间的血压更高，尽管接受的降压药物数量相同。然而，两组之间夜间血压下降或昼夜血压变异性没有显著差异。
在接受多种降压药物治疗的患者中，ABPM 显示血压升高可能提示存在潜在的 PA，但在缺乏其他鉴别特征的情况下，ABPM 无法可靠地区分 PA 与其他类型的高血压。PA 的常规生化筛查仍然是检测这种可治疗的继发性高血压的最可靠方法。
