Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan.
Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Endocr Pract. 2023 Jun;29(6):484-490. doi: 10.1016/j.eprac.2022.10.008. Epub 2022 Oct 20.
Primary aldosteronism (PA) is a highly prevalent yet underdiagnosed secondary cause of hypertension. PA is associated with increased cardiovascular and renal morbidity compared with patients with primary hypertension. Thus, prompt identification and targeted therapy of PA are essential to reduce cardiovascular and renal morbidity and mortality in a large population with hypertension. Unilateral adrenalectomy is preferred for lateralized PA as the only potentially curative therapy. Surgery also mitigates the risk of cardiovascular and renal complications associated with PA. Targeted medical therapy, commonly including a mineralocorticoid receptor antagonist, is offered to patients with bilateral PA and those who are not surgical candidates. Novel therapies, including nonsteroidal mineralocorticoid receptor antagonists and aldosterone synthase inhibitors, are being developed as alternative options for PA treatment. In this review article, we discuss how to best individualize therapy for patients with PA.
原发性醛固酮增多症（PA）是一种高发但未被充分诊断的继发性高血压病因。与原发性高血压患者相比，PA 患者的心血管和肾脏发病率更高。因此，在患有高血压的庞大人群中，及时识别和针对性治疗 PA 对于降低心血管和肾脏发病率和死亡率至关重要。对于单侧病变的 PA，肾上腺切除术是首选的潜在治愈性治疗方法。手术还可以降低与 PA 相关的心血管和肾脏并发症的风险。对于双侧 PA 患者和手术不适合的患者，通常会提供靶向药物治疗，包括盐皮质激素受体拮抗剂。非甾体类盐皮质激素受体拮抗剂和醛固酮合酶抑制剂等新型治疗方法正在被开发为 PA 治疗的替代选择。在这篇综述文章中，我们将讨论如何为 PA 患者制定最佳的个体化治疗方案。
