Doctor of Medicine Programme, Duke National University of Singapore (NUS) Medical School, Singapore, Singapore.
Department of Neurology, National Neuroscience Institute, Singapore, Singapore.
Front Endocrinol (Lausanne). 2022 Apr 19;13:869980. doi: 10.3389/fendo.2022.869980. eCollection 2022.
Primary aldosteronism (PA) is the most common cause of secondary hypertension, and patients are at an increased risk of atrial fibrillation (AF) and stroke. We assessed the prevalence of PA in patients with recent stroke.
We recruited 300 patients admitted to an acute stroke unit with diagnosis of cerebrovascular accident (haemorrhagic/ischaemic) or transient ischaemic attack. Three months post-stroke, plasma renin and aldosterone were measured. Patients with an elevated aldosterone-renin ratio proceeded to the confirmatory saline loading test.
Twenty-six of 192 (14%) patients had an elevated aldosterone-renin ratio. Three of 14 patients who proceeded to saline loading were confirmed with PA (post-saline aldosterone >138 pmol/l). Another three patients were classified as confirmed/likely PA based on the markedly elevated aldosterone-renin ratio and clinical characteristics. The overall prevalence of PA amongst stroke patients with hypertension was 4.0% (95% confidence interval (CI): 0.9%-7.1%). Prevalence of PA was higher amongst patients with cardioembolic stroke, 11% (95% CI: 1.3%-33%), resistant hypertension, 11% (95% CI: 0.3%-48%), and hypertension and AF, 30% (95%CI: 6.7%-65%). If only young patients or those with hypokalaemia were screened for PA, half of our patients with PA would not have been diagnosed. Our decision tree identified that stroke patients with AF and diastolic blood pressure ≥83mmHg were most likely to have PA.
We found that amongst hypertensive patients with stroke, PA was more prevalent in those with AF, or cardioembolic stroke. Screening for PA should be considered for all patients with stroke.
原发性醛固酮增多症（PA）是继发性高血压最常见的病因，此类患者发生心房颤动（AF）和中风的风险增加。我们评估了近期发生中风患者中 PA 的患病率。
我们招募了 300 名因诊断为脑血管意外（出血/缺血性）或短暂性脑缺血发作而入住急性中风病房的患者。中风后 3 个月，测量血浆肾素和醛固酮。醛固酮-肾素比值升高的患者进行盐负荷试验以确诊。
192 例患者中有 26 例（14%）醛固酮-肾素比值升高。14 例进行盐负荷试验的患者中有 3 例被确诊为 PA（盐水后醛固酮>138 pmol/l）。另外 3 例患者根据明显升高的醛固酮-肾素比值和临床特征被归类为确诊/可能的 PA。高血压中风患者中 PA 的总体患病率为 4.0%（95%置信区间：0.9%-7.1%）。心源性栓塞性中风患者中 PA 的患病率较高，为 11%（95%置信区间：1.3%-33%），耐药性高血压为 11%（95%置信区间：0.3%-48%），高血压和 AF 为 30%（95%CI：6.7%-65%）。如果仅筛查年轻患者或低钾血症患者的 PA，我们一半的 PA 患者将不会被诊断。我们的决策树确定，患有 AF 和舒张压≥83mmHg 的中风患者最有可能患有 PA。
我们发现，在患有中风的高血压患者中，PA 在患有 AF 或心源性栓塞性中风的患者中更为常见。所有中风患者都应考虑筛查 PA。
