■很少有研究评估非药物调整的原发性醛固酮增多症(PA)筛查的性能。因此,我们旨在研究调整药物和不调整药物的PA筛查结果之间的一致性,并探讨不调整药物的筛查效果.
■这项前瞻性研究包括650名PA发病率高的连续患者。最初筛查阳性的患者接受了药物调整和确证试验的重新筛查。关于剩下的病人,每3例连续患者中就有1例接受了药物调整和确证试验的重新筛选.比较了原发性高血压(EH)患者和PA患者在药物调整前后醛固酮和肾素浓度的变化。敏感性和特异性用于评估不调整药物的筛查的诊断性能。使用验证性测试结果作为参考。
■我们对650名高血压患者进行PA筛查。49例患者被诊断为PA,195例被诊断为EH。关于毒品,519例患者服用血管紧张素转换酶抑制剂(ACEI),血管紧张素II受体阻滞剂(ARB),钙通道阻滞剂(CCB),或利尿剂单独或联合使用。41名患者正在服用β受体阻滞剂。90名患者服用β受体阻滞剂与其他药物联合使用。在接受ACEI治疗的患者中,ARBs,CCB,或者单独使用利尿剂,或组合,或者单独使用β受体阻滞剂,PA阳性是使用标准确定的,醛固酮与肾素比率(ARR)>38pg/mL/pg/mL,血浆醛固酮浓度(PAC)>100pg/mL,和消极情绪,使用标准,ARR<9pg/mL/pg/mL;敏感性和特异性分别为94.7%和94.5%,分别。药物调整后,筛查的敏感性和特异性分别为92.1%和89%,分别。
■在未联合使用β受体阻滞剂治疗的患者中,当ARR>38pg/mL/pg/mL和血浆醛固酮浓度(PAC)>100pg/mL时,或者,ARR<9pg/mL/pg/mL,非药物调整的筛查结果与药物调整的结果相同.非药物调整筛查可以减少药物调整的机会,使患者能够继续治疗并避免不良反应,具有临床重要性。
原发性醛固酮增多症(PA)是内分泌高血压的最常见形式。中风的风险,心肌梗塞,心力衰竭,心房颤动,PA的肾功能恶化高于原发性高血压(EH),即使血压(BP)水平相同。然而,许多患者仍未确诊,因为大多数抗高血压药物会严重干扰PA筛查结果,这使得药物调整成为必要。这可能是一个耗时且不安全的过程,需要4-6周,并可能导致高血压危象和其他并发症。一些研究表明,某些抗高血压药物可以在PR筛查期间继续使用。然而,很少有研究评估非药物调整PA筛查的性能.因此,在这项前瞻性研究中,我们旨在比较高血压和PA高危患者调整药物前后,并以确证试验结果为参考,探讨诊断或排除效果.我们发现,在特定患者组中,非药物调整的筛查与药物调整的筛查相似。我们的发现可以帮助防止不必要的药物调整PA筛查,从而降低这些患者的风险。
UNASSIGNED: Few studies have evaluated the performance of non-drug-adjusted primary aldosteronism (PA) screening. Therefore, we aimed to examine the consistency between PA screening results with and without drug adjustment and to explore the effectiveness of screening without drug adjustment.
UNASSIGNED: This prospective study included 650 consecutive patients with a high risk of incidence PA. Patients who initially screened positive underwent rescreening with drug adjustments and confirmatory tests. Regarding the remaining patients, one of every three consecutive patients underwent rescreening with drug adjustments and confirmatory tests. The changes in aldosterone and renin concentrations were compared between patients with essential hypertension (EH) and those with PA before and after drug adjustment. Sensitivity and specificity were used to assess the diagnostic performance of screening without drug adjustment, using the confirmatory test results as the reference.
UNASSIGNED: We screened 650 patients with hypertension for PA. Forty-nine patients were diagnosed with PA and 195 with EH. Regarding drugs, 519 patients were taking angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), or diuretics alone or in combination. Forty-one patients were taking beta-blockers. Ninety patients were taking beta-blockers in combination with other drugs. In patients treated with ACEIs, ARBs, CCBs, or diuretics alone, or in combination, or beta-blockers alone, PA positivity was determined using the criteria, aldosterone-to-renin ratio (ARR) >38 pg/mL/pg/mL and plasma aldosterone concentration (PAC) >100 pg/mL, and negativity, using the criteria, ARR <9 pg/mL/pg/mL; the sensitivity and specificity were 94.7% and 94.5%, respectively. After drug adjustment, the sensitivity and specificity of screening were 92.1% and 89%, respectively.
UNASSIGNED: In patients not treated with beta-blockers combined with others, when ARR >38 pg/mL/pg/mL and plasma aldosterone concentration (PAC) >100 pg/mL, or, ARR <9 pg/mL/pg/mL, non-drug-adjusted screening results were identical to with drug adjustment. Non-drug-adjusted screening could reduce the chance of medication adjustment, enable patients to continue their treatments and avoiding adverse effects, is of clinical importance.
Primary aldosteronism (PA) is the most common form of endocrine hypertension. The risk of stroke, myocardial infarction, heart failure, atrial fibrillation, and deterioration of kidney function is higher in PA than in essential hypertension (EH), even with the same blood pressure (BP) levels. However, many patients remain undiagnosed because most antihypertensive drugs substantially interfere with PA screening results, which makes drug adjustment necessary. This can be a time-consuming and unsafe process, requiring 4–6 weeks, and could lead to a hypertensive crisis and other complications. Some studies have suggested that certain antihypertensive drugs can be continued during PR screening. However, few studies have evaluated the performance of non-drug-adjusted PA screening. Therefore, in this prospective study, we aimed to compare patients with hypertension and a high risk of PA before and after drug adjustment and to use confirmatory test results as a reference to explore the diagnostic or exclusion effect. We found that non-drug-adjusted screening performs similarly to drug-adjusted screening in a particular group of patients. Our findings could aid in preventing unnecessary drug adjustment for PA screening, thereby reducing the risk in these patients.