Division of Metabolism, Endocrinology, and Diabetes University of Michigan Ann Arbor MI.
School of Public Health University of Michigan Ann Arbor MI.
J Am Heart Assoc. 2022 Jul 19;11(14):e025952. doi: 10.1161/JAHA.122.025952. Epub 2022 Jul 8.
Background Primary aldosteronism (PA) is a common but under-recognized cause of secondary hypertension. Data directly comparing screening rates across single and overlapping indications are lacking. Methods and Results We conducted a retrospective review of adults with hypertension seen in outpatient clinics at a tertiary referral academic center between January 1, 2017, and June 30, 2020. We included patients with hypertension plus at least one of the following: resistant hypertension; age<35 years; obstructive sleep apnea; hypokalemia; or an adrenal mass. We excluded patients with adrenal insufficiency, severe renal disease, or heart failure, and renovascular hypertension. Of 203 535 patients with hypertension, 86044 (42.3%) met at least 1 PA screening criterion, and of these, 2898 (3.4%) were screened for PA. Screening occurred in 2.7% of patients with resistant hypertension; 4.2% of those with obstructive sleep apnea; 5.1% of those <35 years; 10.0% of those with hypokalemia; and 47.3% of patients with an adrenal mass. Screening rates were higher in patients with multiple risk factors: 16.8% for ≥3, 5.7% for 2, and 2.5% for 1 criterion. Multiple logistic regression showed that the odds of PA screening were higher in patients with hypokalemia: odds ratio (95% CI): 3.0 (2.7-3.3); women: 1.3 (1.2-1.4); Black versus White: 1.5 (1.4-1.7); those with obstructive sleep apnea, chronic renal disease, stroke, and dyslipidemia. Conclusions Consideration for PA is given in a small subset of at-risk patients, and typically after comorbidities have developed.
原发性醛固酮增多症（PA）是继发性高血压的常见但未被充分认识的病因。缺乏直接比较单一和重叠适应证下筛查率的数据。
我们对 2017 年 1 月 1 日至 2020 年 6 月 30 日期间在三级转诊学术中心的门诊就诊的高血压成年患者进行了回顾性研究。我们纳入了高血压合并以下至少一项的患者：难治性高血压；年龄<35 岁；阻塞性睡眠呼吸暂停；低钾血症；或肾上腺肿块。我们排除了肾上腺功能不全、严重肾功能不全或心力衰竭以及肾血管性高血压的患者。在 203535 例高血压患者中，86044 例（42.3%）至少符合 1 项 PA 筛查标准，其中 2898 例（3.4%）接受了 PA 筛查。在难治性高血压患者中，筛查率为 2.7%；阻塞性睡眠呼吸暂停患者中为 4.2%；<35 岁患者中为 5.1%；低钾血症患者中为 10.0%；肾上腺肿块患者中为 47.3%。有多种危险因素的患者筛查率更高：≥3 个危险因素患者中为 16.8%，2 个危险因素患者中为 5.7%，1 个危险因素患者中为 2.5%。多因素逻辑回归显示，低钾血症患者进行 PA 筛查的可能性更高：优势比（95%置信区间）：3.0（2.7-3.3）；女性：1.3（1.2-1.4）；黑人与白人：1.5（1.4-1.7）；患有阻塞性睡眠呼吸暂停、慢性肾脏病、中风和血脂异常的患者。
只有一小部分高危患者会考虑 PA，通常是在出现合并症之后。
