Hypertension: 难治性高血压患者应加强醛固酮增多症筛查

2020-03-03 国际循环 国际循环

与原发性高血压相比,难治性高血压与心血管疾病、肾脏疾病和死亡风险增加的相关性更高。尽管临床实践指南建议对难治性高血压进行原发性醛固酮增多症筛查,但尚无确切检出率。近期,Hypertension杂志发表研究对此进行分析。


与原发性高血压相比,难治性高血压与心血管疾病、肾脏疾病和死亡风险增加的相关性更高。尽管临床实践指南建议对难治性高血压进行原发性醛固酮增多症筛查,但尚无确切检出率。近期,Hypertension杂志发表研究对此进行分析。
 
研究共确定145 670例高血压患者,排除充血性心力衰竭或晚期慢性肾病患者。在这组人群中,研究纳入2008年至2014年4660例年龄在18岁至90岁的难治性高血压患者,并在之后的24个月内对其进行持续实验室检查。难治性高血压患者的原发性醛固酮增多症筛查率为2.1%。与未筛查人群相比,受筛查者较年轻(55.9±13.3 vs. 65.5±11.6岁;P<0.0001)、收缩压(145.1±24.3 vs. 139.6±20.5 mm Hg;P=0.04)、舒张压(81.8±13.6 vs. 74.4±13.8 mm Hg;P<0.0001)、冠心病发病率(5.2% vs. 14.2%;P=0.01)和血清钾浓度(3.9±0.6 vs. 4.1±0.5 mmol/L;P=0.04)均较低。同时,受筛查患者的钙通道阻滞剂、混合α/β肾上腺素受体拮抗剂、交感神经药物和血管舒张剂的处方率显著高于未筛查人群,环噻嗪和噻嗪类利尿剂的处方率显著低于未筛查人群。此外,二者盐皮质激素受体拮抗剂或其他保钾利尿剂的处方率无显著差异(P=0.20)。
 
研究显示,符合难治性高血压醛固醇增多症筛查标准人群中,2年内接受筛查的比例为2.1%,尽管临床担心抗高血压药物处方对筛选结果造成干扰,但这并非筛查率低主要原因。研究人员认为,目前临床仍应坚持遵循指南对难治性高血压患者进行醛固酮增多症筛查。
 
参考文献:
Gilad Jaffe, Zachary Gray, et al. Screening Rates for Primary Aldosteronism in Resistant Hypertension: A Cohort Study. Hypertension. Originally published3 Feb 2020.

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    2020-07-10 feather89
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    2020-03-05 cmsvly
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    2020-03-05 freve
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    2020-03-03 1209e435m98(暂无昵称)

    学习了,谢谢分享

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