Yoshida Yuichi, Shibata Hirotaka
Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
Hypertens Res. 2025 Feb;48(2):854-861. doi: 10.1038/s41440-024-01970-7. Epub 2024 Nov 29.
Primary aldosteronism (PA) is a prevalent and curable secondary hypertensive disorder that accounts for 5-13% of all hypertension cases. The prevalence of resistant hypertension, cerebral and cardiovascular diseases, and renal complications is higher in PA patients than in those with essential hypertension. Appropriate diagnosis and treatment at an early stage may suppress cerebral and cardiovascular events. Lifestyle modifications recommended for essential hypertensive patients, including dietary salt restriction and appropriate calorie intake to avoid fat accumulation, play a crucial role in suppressing overactivation of the mineralocorticoid receptor (MR), which helps to control blood pressure and prevent end-organ damage. Esaxerenone is a safe mineralocorticoid receptor antagonist (MRA) with strong antihypertensive and anti-albuminuric effects. Aldosterone synthase inhibitors (ASIs) have been developed, which are antihypertensive agents with a new mechanism of action. The pharmacological mechanisms of MRAs and ASIs differ; MRAs block MR activity by preventing aldosterone and/or cortisol from binding to the MR, while ASIs block aldosterone secretion from the adrenal gland. Other new treatments, such as robot-assisted laparoscopic adrenalectomy, percutaneous computed tomography radiofrequency ablation, transvenous radiofrequency catheter ablation, and super-selective adrenal arterial embolization have been developed. Further research will lead to better treatments for PA patients and reduce the frequency of cerebral and cardiovascular events.
原发性醛固酮增多症（PA）是一种常见且可治愈的继发性高血压疾病，占所有高血压病例的5%-13%。PA患者中难治性高血压、脑血管和心血管疾病以及肾脏并发症的患病率高于原发性高血压患者。早期进行适当的诊断和治疗可能会抑制脑血管和心血管事件。推荐给原发性高血压患者的生活方式改变，包括限制饮食中的盐分和适当摄入热量以避免脂肪堆积，在抑制盐皮质激素受体（MR）过度激活方面起着关键作用，这有助于控制血压并预防靶器官损害。依普利酮是一种安全的盐皮质激素受体拮抗剂（MRA），具有强大的降压和抗蛋白尿作用。已经开发出醛固酮合成酶抑制剂（ASI），它们是具有新作用机制的降压药物。MRA和ASI的药理机制不同；MRA通过阻止醛固酮和/或皮质醇与MR结合来阻断MR活性，而ASI则阻断肾上腺分泌醛固酮。还开发了其他新的治疗方法，如机器人辅助腹腔镜肾上腺切除术、经皮计算机断层扫描射频消融术、经静脉射频导管消融术和超选择性肾上腺动脉栓塞术。进一步的研究将为PA患者带来更好的治疗方法，并减少脑血管和心血管事件的发生频率。
