Department of Hypertension, National Institute of Cardiology, Warsaw, Poland.
Innovative Laboratory Diagnostic Centre, John Paul II Hospital, Cracow, Poland.
Clin Endocrinol (Oxf). 2022 Feb;96(2):114-122. doi: 10.1111/cen.14638. Epub 2021 Nov 14.
The aim of the study was to investigate a new possible background of increased risk of cardiovascular events in two forms of endocrine hypertension: in primary aldosteronism (PA) and pheochromocytoma/paraganglioma (PPGL) in comparison to essential hypertension (EHT).
Prothrombotic properties of the fibrin clot structure, impaired fibrinolysis and enhanced thrombin generation have been reported to be associated with increased cardiovascular risk.
Patients with PA and PPGL were evaluated at baseline and re-evaluated 3 months after causative treatment. At baseline PA and PPGL patients were compared to matched EHT patients and to healthy controls.
The study included 35 patients with PA, 16 patients with PPGL and two reference groups of patients with EHT (32 and 22 patients) and healthy controls (35 and 23 subjects).
All subjects underwent evaluation according to the study protocol that included plasma fibrin clot permeability (Ks), clot lysis time, endogenous thrombin potential.
There were no differences in clot structure and fibrinolytic activity in PA and PPGL patients as compared to matched patients with EHT, whereas all hypertensive groups were characterized by more compact fibrin clot structure, faster clot formation and enhanced thrombin generation in comparison to healthy controls. Both in PA and PPGL patients, fibrin clot properties and fibrinolytic parameters remained stable after the causative treatment.
Patients with PA and PPGL are at a prothrombic state comparable to patients with EHT. The results suggest the higher risk of cardiovascular events observed in hypertensive PA and PPGL as compared to EHT is not mediated through investigated prothrombic mechanisms.
本研究旨在探讨原发性醛固酮增多症（PA）和嗜铬细胞瘤/副神经节瘤（PPGL）这两种内分泌性高血压与原发性高血压（EHT）相比，心血管事件风险增加的一个新的可能原因。
已有研究报道，纤维蛋白凝块结构的促血栓形成特性、纤溶受损和凝血酶生成增强与心血管风险增加相关。
PA 和 PPGL 患者在基线时进行评估，并在病因治疗后 3 个月进行重新评估。在基线时，将 PA 和 PPGL 患者与匹配的 EHT 患者和健康对照组进行比较。
该研究纳入了 35 例 PA 患者、16 例 PPGL 患者以及 EHT（32 例和 22 例）和健康对照组（35 例和 23 例）的两个参考组患者。
所有受试者均根据研究方案进行评估，该方案包括血浆纤维蛋白凝块通透性（Ks）、凝块溶解时间、内源性凝血酶潜能。
与匹配的 EHT 患者相比，PA 和 PPGL 患者的凝块结构和纤维蛋白溶解活性没有差异，而所有高血压组的纤维蛋白凝块结构更紧密，形成凝块更快，凝血酶生成增强，与健康对照组相比。在 PA 和 PPGL 患者中，病因治疗后，纤维蛋白凝块特性和纤维蛋白溶解参数保持稳定。
PA 和 PPGL 患者处于与 EHT 患者相当的促血栓形成状态。这些结果表明，与 EHT 相比，在高血压性 PA 和 PPGL 中观察到的心血管事件风险增加并非通过所研究的促血栓形成机制介导。
