Division of Nephrology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario.
Division of Endocrinology and Metabolism, Department of Medicine.
Curr Opin Nephrol Hypertens. 2021 May 1;30(3):353-360. doi: 10.1097/MNH.0000000000000702.
Primary aldosteronism, characterized by renin-independent aldosterone secretion from one or both adrenal glands, is the most common and modifiable form of secondary hypertension. The prevalence of primary aldosteronism is increasingly recognized to be much higher than previously thought with many cases still undetected.
Prior prevalence studies on primary aldosteronism have reported a wide range of estimates due to heterogeneity of both disease definitions and study populations such that it is difficult to claim a single point estimate. More recent evidence demonstrates that primary aldosteronism, as defined by conventional biochemical diagnostic criteria, is highly prevalent within populations where it is not typically considered such as mild-to-moderate hypertension, prehypertension, and even normotension. Yet, our current screening approach fails to capture many cases. Furthermore, there is mounting evidence that renin-independent aldosteronism exists as a continuum of disease that extends below the current biochemical diagnostic thresholds used to define primary aldosteronsim and has clinically relevant treatment and outcome implications for a much broader patient population. Indeed, much of what we current label as 'essential hypertension' is, in fact, renin-independent aldosterone-mediated hypertension.
Primary aldosteronism and milder forms of renin-independent aldosteronism are highly prevalent, yet vastly under-recognized, in the general population.
原发性醛固酮增多症的特征是一个或两个肾上腺的肾素非依赖性醛固酮分泌，是最常见和可改变的继发性高血压形式。原发性醛固酮增多症的患病率越来越被认为比以前认为的要高得多，许多病例仍未被发现。
由于疾病定义和研究人群的异质性，以前关于原发性醛固酮增多症的患病率研究报告了广泛的估计值，因此很难声称有一个单一的估计值。最近的证据表明，根据传统的生化诊断标准定义的原发性醛固酮增多症在人群中发病率很高，这些人群通常不被认为是轻度至中度高血压、高血压前期，甚至正常血压。然而，我们目前的筛查方法未能发现许多病例。此外，越来越多的证据表明，肾素非依赖性醛固酮症是一种连续的疾病，其延伸到目前用于定义原发性醛固酮增多症的生化诊断阈值以下，对更广泛的患者群体具有临床相关的治疗和预后意义。事实上，我们目前标记为“原发性高血压”的大部分实际上是肾素非依赖性醛固酮介导的高血压。
原发性醛固酮增多症和更温和的肾素非依赖性醛固酮症在普通人群中高度流行，但却被严重低估。
