Wang Qian, Dong Hui, Li Hongwu, Zuo Yujie, Zou Yubao, Jiang Xiongjing
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Clin Hypertens (Greenwich). 2025 Mar;27(3):e70031. doi: 10.1111/jch.70031.
We conducted a retrospective cohort study to investigate changes in the aldosterone-to-renin ratio (ARR) and other influencing factors in patients with renal artery stenosis (RAS) and primary aldosteronism (PA). Patients with RAS and PA admitted to our hospital between January 2016 and December 2021 were retrospectively selected. Based on the standardized PA screening results, the patients were divided into aldosterone-to-renin ratio-positive and -negative groups. The clinical features of the patients were compared. Binary logistic regression analysis was performed to identify the factors contributing to the comorbidity of RAS with false-negative PA. A total of 78 patients (mean age: 60.2 ± 10.2 years) were selected, among whom 46 (59%) were male. Overall, 69 patients had Stage 3 hypertension (88.5%) and 57 had hypokalemia (73.1%). Additionally, 42 (53.8%) and 36 (46.2%) patients were aldosterone-to-renin ratio-positive and -negative, respectively. The aldosterone-to-renin ratio-positive group showed significant differences in malignant hypertension (2.4% vs. 27.8%; p = 0.002), Stage 3 hypertension (81.0% vs. 97.2%; p = 0.033), and RAS degree (64.3 ± 16.4% vs. 71.8 ± 14.4%; p = 0.032). Malignant hypertension (odds ratio, 15.250; 95% confidence interval, 1.787-130.132; p = 0.013) and RAS degree (odds ratio, 1.034; 95% confidence interval, 1.002-1.068; p = 0.036) influenced the comorbidity of RAS with false-negative PA. Malignant hypertension and severe RAS can contribute to false-negative PA results. Therefore, PA screening test results should be carefully analyzed and rechecked following RAS treatment to confirm the presence of PA.
我们进行了一项回顾性队列研究，以调查肾动脉狭窄（RAS）和原发性醛固酮增多症（PA）患者的醛固酮与肾素比值（ARR）变化及其他影响因素。回顾性选取了2016年1月至2021年12月期间我院收治的RAS和PA患者。根据标准化的PA筛查结果，将患者分为醛固酮与肾素比值阳性组和阴性组。比较患者的临床特征。进行二元逻辑回归分析，以确定导致RAS与PA假阴性合并存在的因素。共选取78例患者（平均年龄：60.2±10.2岁），其中46例（59%）为男性。总体而言，69例患者患有3级高血压（88.5%），57例患有低钾血症（73.1%）。此外，醛固酮与肾素比值阳性组和阴性组分别有42例（53.8%）和36例（46.2%）患者。醛固酮与肾素比值阳性组在恶性高血压（2.4%对27.8%；p=0.002）、3级高血压（81.0%对97.2%；p=0.033）和RAS程度（64.3±16.4%对71.8±14.4%；p=0.032）方面存在显著差异。恶性高血压（比值比，15.250；95%置信区间，1.787 - 130.132；p=0.013）和RAS程度（比值比，1.034；95%置信区间，1.002 - 1.068；p=0.036）影响RAS与PA假阴性合并存在。恶性高血压和严重RAS可导致PA假阴性结果。因此，应仔细分析PA筛查试验结果，并在RAS治疗后重新检查以确认PA的存在。
