Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Division of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan.
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Division of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan.
Atherosclerosis. 2021 May;324:84-90. doi: 10.1016/j.atherosclerosis.2021.03.033. Epub 2021 Mar 29.
We used a dataset from a Japanese nationwide registry of patients with primary aldosteronism, to determine which of the parameters of hyperaldosteronism and blood pressure before or after treatments for primary aldosteronism (i.e., surgical adrenalectomy or a medication treatment) are important in terms of cardiovascular prognosis.
We assessed whether plasma aldosterone-to-renin ratio and pulse pressure levels before treatment and 6 months after treatment were associated with composite cardiovascular disease events during the 5-year follow-up period.
The cohort included 1987 patients (mean age was 53.2 years, 52.0% were female, 37.2% had undergone surgical treatment, and the remainder had been treated with mineralocorticoid receptor antagonists). In the Cox proportional hazard model, the covariate-adjusted hazard ratio (95% confidence interval) for the composite cardiovascular disease events risk for each one-standard-deviation increase in the aldosterone-to-renin ratio or pulse pressure before treatment, those after treatment, or the duration of hypertension were 1.24 (1.05, 1.48), 0.74 (0.54, 1.02), and 1.07 (0.79, 1.44), 1.43 (1.07, 1.92), and 1.52 (1.19, 1.95), respectively. Patients with a high pre-treatment aldosterone-to-renin ratio of more than 603 and a large post-treatment pulse pressure of more than 49 mmHg showed approximately three-fold higher hazard ratios for cardiovascular events risk compared to those with a lower aldosterone-to-renin ratio and smaller pulse pressure.
Higher aldosterone-to-renin ratio before treatments, higher pulse pressure after treatments, and longer duration of hypertension were prognostic factors for cardiovascular diseases. Early intervention may be important for preventing cardiovascular disease among patients with primary aldosteronism.
我们使用了来自日本原发性醛固酮增多症患者全国登记处的数据，旨在确定原发性醛固酮增多症治疗前后（即肾上腺切除术或药物治疗）的高醛固酮血症和血压参数中哪些与心血管预后有关。
我们评估了治疗前和治疗后 6 个月时的血浆醛固酮与肾素比值和脉压水平与 5 年随访期间复合心血管疾病事件之间的关系。
该队列纳入了 1987 例患者（平均年龄为 53.2 岁，52.0%为女性，37.2%接受了手术治疗，其余患者接受了盐皮质激素受体拮抗剂治疗）。在 Cox 比例风险模型中，治疗前、治疗后或高血压持续时间每增加一个标准差时，醛固酮与肾素比值或脉压增加与复合心血管疾病事件风险的校正风险比（95%置信区间）分别为 1.24（1.05，1.48）、0.74（0.54，1.02）和 1.07（0.79，1.44）、1.43（1.07，1.92）和 1.52（1.19，1.95）。治疗前醛固酮与肾素比值大于 603 和治疗后脉压大于 49mmHg 的患者发生心血管事件的风险比约为比值和脉压较低的患者的三倍。
治疗前较高的醛固酮与肾素比值、治疗后较高的脉压和较长的高血压持续时间是心血管疾病的预后因素。早期干预可能对预防原发性醛固酮增多症患者的心血管疾病很重要。
