Subtype Identification of Surgically Curable Primary Aldosteronism During Treatment With Mineralocorticoid Receptor Blockade

被引：4

作者：

Pintus, Giovanni ^{[1
,3
]}

Seccia, Teresa Maria ^{[1
]}

Amar, Laurence ^{[4
,5
]}

Azizi, Michel ^{[4
,5
]}

Riester, Anna ^{[6
]}

Reincke, Martin ^{[6
]}

Widimsky, Jiri ^{[7
,8
,9
]}

Naruse, Mitsuhide ^{[10
,11
]}

Kocjan, Tomaz ^{[12
]}

Negro, Aurelio ^{[13
,14
]}

Kline, Gregory ^{[15
]}

Tanabe, Akiyo ^{[16
]}

Satoh, Fumitoshi ^{[17
]}

Rump, Lars Christian ^{[18
]}

Vonend, Oliver ^{[18
]}

Fuller, Peter J. ^{[19
]}

Yang, Jun ^{[19
]}

Chee, Nicholas Yong Nian ^{[19
]}

Magill, Steven B. ^{[20
]}

Shafigullina, Zulfiya ^{[21
]}

Quinkler, Marcus ^{[22
]}

Oliveras, Anna ^{[23
]}

Lee, Bo-Ching ^{[24
]}

Chang, Chin-Chen ^{[24
,25
]}

Wu, Vin-Cent ^{[25
,26
]}

Kratka, Zuzana ^{[7
,8
,9
]}

Battistel, Michele ^{[2
,23
]}

Bagordo, Domenico ^{[1
]}

Caroccia, Brasilina ^{[1
]}

Ceolotto, Giulio ^{[1
]}

Rossitto, Giacomo ^{[1
]}

Rossi, Gian Paolo ^{[1
]}

机构：

[1] Univ Padua, Specialized Ctr Blood Pressure Disorders Reg Venet, Dept Med, Internal Emergency Med Unit, I-35128 Padua, Italy

[2] Univ Padua, Inst Radiol, Padua, Italy

[3] Sapienza Univ Rome, Dept Translat & Precis Med, Rome, Italy

[4] Univ Paris Cite, INSERM, UMRS 970 & CIC1418, Paris, Italy

[5] Hop Europeen Georges Pompidou, AP HP, Hypertens Unit, Paris, France

[6] Ludwig Maximilian Univ Munich LMU, Dept Med 4, LMU Munich, Univ Hosp, Munich, Germany

[7] 1st Fac Med, Dept Med 3, Prague, Czech Republic

[8] 1st Fac Med, Dept Endocrinol & Metab, Prague, Czech Republic

[9] Gen Univ Hosp, Prague, Czech Republic

[10] Natl Hosp Org Kyoto Med Ctr, Clin Res Inst, Dept Endocrinol, Kyoto, Japan

[11] Ijinkai Takeda Gen Hosp, Endocrine Ctr, Kyoto, Japan

[12] Univ Ljubljana, Univ Med Ctr Ljubljana, Fac Med, Ljubljana, Slovenia

[13] Osped St Anna Castelnovo Ne Monti, Internal Med & Hypertens Ctr, Castelnovo Ne Monti, Italy

[14] Ist Ricovero & Cura Carattere Sci ULS IRCCS Reggio, Azienda Unita Sanit Locale, Reggio Emilia, Italy

[15] Univ Calgary, Foothills Med Ctr, Calgary, AB, Canada

[16] Natl Ctr Global Hlth & Med, Dept Diabet Endocrinol & Metab, Tokyo, Japan

[17] Tohoku Univ Hosp, Dept Nephrol Endocrinol & Vasc Med, Sendai, Japan

[18] Heinrich Heine Univ Dusseldorf, Univ Hosp Dusseldorf, Med Fac, Dept Nephrol, Dusseldorf, Germany

[19] Monash Hlth, Clayton, Vic, Australia

[20] Med Coll Wisconsin, Endocrinol Ctr, North Hills Hlth Ctr, Menomonee Falls, WI USA

[21] North Western State Med Univ, Dept Endocrinol, St Petersburg, Russia

[22] Endocrinol Charlottenburg, Berlin, Germany

[23] Univ Pompeu Fabra, Hosp del Mar, Nephrol Dept, Hypertens Unit, Barcelona, Spain

[24] Natl Taiwan Univ Hosp, Dept Med Imaging, Taipei, Taiwan

[25] Natl Taiwan Univ, Coll Med, Taipei, Taiwan

[26] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei, Taiwan

来源：

HYPERTENSION | 2024年 / 81卷 / 06期

关键词：

aldosterone; blood pressure; hyperaldosteronism; hypertension; mineralocorticoid receptor antagonists; renin; DISCONTINUATION;

D O I：

10.1161/HYPERTENSIONAHA.124.22721

中图分类号：

R6 [外科学];

学科分类号：

1002 ; 100210 ;

摘要：

BACKGROUND: Current guidelines and consensus documents recommend withdrawal of mineralocorticoid receptor antagonists (MRAs) before primary aldosteronism (PA) subtyping by adrenal vein sampling (AVS), but this practice can cause severe hypokalemia and uncontrolled high blood pressure. Our aim was to investigate if unilateral PA can be identified by AVS during MRA treatment. METHODS:We compared the rate of unilateral PA identification between patients with and without MRA treatment in large data sets of patients submitted to AVS while off renin-angiotensin system blockers and beta-blockers. In sensitivity analyses, the between-group differences of lateralization index values after propensity score matching and the rate of unilateral PA identification in subgroups with undetectable (<= 2 mUI/L), suppressed (<8.2 mUI/L), and unsuppressed (>= 8.2 mUI/L) direct renin concentration levels were also evaluated. RESULTS: Plasma aldosterone concentration, direct renin concentration, and blood pressure values were similar in non-MRA-treated (n=779) and MRA-treated (n=61) patients with PA, but the latter required more antihypertensive agents (P=0.001) and showed a higher rate of adrenal nodules (82% versus 67%; P=0.022) and adrenalectomy (72% versus 54%; P=0.01). However, they exhibited no significant differences in commonly used AVS indices and the area under the receiving operating characteristic curve of lateralization index, both under unstimulated conditions and postcosyntropin. Several sensitivity analyses confirmed these results in propensity score matching adjusted models and in patients with undetectable, or suppressed or unsuppressed renin levels. CONCLUSIONS: At doses that controlled blood pressure and potassium levels, MRAs did not preclude the identification of unilateral PA at AVS. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01234220.

引用

页码：1391 / 1399

页数：9