Department of Medicine, Center for Adrenal Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Medicine (Division of Nephrology) and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Am J Hypertens. 2022 Dec 8;35(12):967-988. doi: 10.1093/ajh/hpac079.
We are witnessing a revolution in our understanding of primary aldosteronism (PA). In the past 2 decades, we have learned that PA is a highly prevalent syndrome that is largely attributable to pathogenic somatic mutations, that contributes to cardiovascular, metabolic, and kidney disease, and that when recognized, can be adequately treated with widely available mineralocorticoid receptor antagonists and/or surgical adrenalectomy. Unfortunately, PA is rarely diagnosed, or adequately treated, mainly because of a lack of awareness and education. Most clinicians still possess an outdated understanding of PA; from primary care physicians to hypertension specialists, there is an urgent need to redefine and reintroduce PA to clinicians with a modern and practical approach. In this state-of-the-art review, we provide readers with the most updated knowledge on the pathogenesis, prevalence, diagnosis, and treatment of PA. In particular, we underscore the public health importance of promptly recognizing and treating PA and provide pragmatic solutions to modify clinical practices to achieve this.
我们正在见证原发性醛固酮增多症（PA）认识的革命。在过去的 20 年里，我们了解到 PA 是一种高度普遍的综合征，主要归因于致病性体突变，导致心血管、代谢和肾脏疾病，如果得到识别，可以用广泛可用的盐皮质激素受体拮抗剂和/或肾上腺切除术进行充分治疗。不幸的是，PA 很少被诊断出来，或者治疗不充分，主要是因为缺乏认识和教育。大多数临床医生仍然对 PA 有过时的认识；从初级保健医生到高血压专家，都迫切需要用现代实用的方法重新定义和向临床医生介绍 PA。在这篇最新综述中，我们为读者提供了关于 PA 的发病机制、患病率、诊断和治疗的最新知识。特别是，我们强调了及时识别和治疗 PA 的公共卫生重要性，并提供了切实可行的解决方案来改变临床实践以实现这一目标。
