Department of Medicine-DIMED, Emergency and Hypertension Unit, University of Padova, University Hospital, via Giustiniani, 2, 35126 Padova, Italy.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Eur J Prev Cardiol. 2022 Mar 11;29(2):e85-e93. doi: 10.1093/eurjpc/zwaa108.
We aimed at determining the rate of drug-resistant arterial hypertension in patients with an unambiguous diagnosis of primary aldosteronism (PA). Moreover, we sought for investigating the diagnostic performance of adrenal vein sampling (AVS), and the effect of adrenalectomy on blood pressure (BP) and prior treatment resistance in PA patients subtyped by AVS in major referral centres.
The Adrenal Vein Sampling International Study-2 (AVIS-2) was a multicentre international study that recruited consecutive PA patients submitted to AVS, according to current guidelines, during 15 years. The patients were over 18 years old with arterial hypertension and had an unambiguous diagnosis of PA. The rate of resistant hypertension was assessed at baseline and after adrenalectomy using the American Heart Association (AHA) 2018 definition. Information on presence or absence of resistant hypertension was available in 89% of the 1625 enrolled PA patients. Based on the AHA 2018 criteria, resistant hypertension was found in 20% of patients, of which about two-thirds (14%) were men and one-third (6%) women (χ2 = 17.1, P < 110-4) with a higher rate of RH in men than in women (23% vs. 15% P < 110-4). Of the 292 patients with resistant hypertension, 98 (34%) underwent unilateral AVS-guided adrenalectomy, which resolved BP resistance to antihypertensive treatment in all.
(i) Resistant hypertension is a common presentation in patients seeking surgical cure of PA; (ii) AVS is key for the optimal management of patients with PA due to resistant hypertension; and (iii) AVS-guided adrenalectomy allowed resolution of treatment-resistant hypertension.
我们旨在确定原发性醛固酮增多症（PA）患者中明确诊断为耐药性动脉高血压的比率。此外，我们还研究了肾上腺静脉采样（AVS）的诊断性能，以及在主要转诊中心根据 AVS 对 PA 患者进行亚型分类后，肾上腺切除术对血压（BP）和先前治疗抵抗的影响。
肾上腺静脉采样国际研究-2（AVIS-2）是一项多中心国际研究，在 15 年内根据当前指南招募了连续接受 AVS 的 PA 患者。患者年龄超过 18 岁，患有动脉高血压，并明确诊断为 PA。使用美国心脏协会（AHA）2018 年的定义，在基线和肾上腺切除术后评估难治性高血压的发生率。在纳入的 1625 名 PA 患者中，有 89%可获得存在或不存在难治性高血压的信息。根据 AHA 2018 标准，20%的患者存在难治性高血压，其中约三分之二（14%）为男性，三分之一（6%）为女性（χ2 = 17.1，P < 110-4），男性的 RH 发生率高于女性（23%比 15%，P < 110-4）。在 292 名难治性高血压患者中，98 名（34%）接受了单侧 AVS 引导的肾上腺切除术，所有患者的抗高血压治疗抵抗性血压均得到解决。
（i）难治性高血压是寻求 PA 手术治疗的患者的常见表现；（ii）AVS 是管理因难治性高血压而导致的 PA 患者的关键；（iii）AVS 引导的肾上腺切除术可解决治疗抵抗性高血压。
