背景:在某些指南中,建议将高血压合并阻塞性睡眠呼吸暂停(OSA)作为筛查原发性醛固酮增多症(PA)的指征,然而,先前的数据使这一建议的有效性受到质疑.鉴于这种情况,目前尚不清楚这项筛查建议是否正在临床实践中实施.
方法:我们对2009-2020年所有患有高血压合并OSA的安大略省(加拿大)成年居民进行了一项基于人群的回顾性队列研究,并利用省级卫生行政数据进行了2021年的随访。我们测量了通过醛固酮与肾素比率进行PA筛查的个体的比例。我们进一步检查了合并低钾血症和顽固性高血压的高血压合并OSA患者的筛查率。通过Cox回归模型评估与筛查相关的临床预测因子。
结果:研究队列包括53,130名患有高血压和OSA的成年人,其中只有634(1.2%)进行了PA筛查。在高血压患者中,OSA,和低钾血症,筛选合格患者的比例上升至2.8%.在≥65岁的高血压患者中,OSA,和处方≥4种降压药物,筛选合格患者的比例为1.8%.年龄较大与筛查的可能性降低相关,而低钾血症和内科亚专科护理,心脏病学,内分泌学,或肾脏病与筛查的可能性增加相关.没有发现筛查与性别有关,农村住宅,心血管疾病,糖尿病,或者呼吸专科护理.
结论:筛查所有高血压合并OSA患者PA的指南建议的人群水平极低。
Hypertension plus obstructive sleep apnea (OSA) is recommended in some guidelines as an indication to screen for primary aldosteronism (PA), yet prior data has brought the validity of this recommendation into question. Given this context, it remains unknown whether this screening recommendation is being implemented into clinical practice.
We conducted a population-based retrospective cohort study of all adult Ontario (Canada) residents with hypertension plus OSA from 2009 to 2020 with follow-up through 2021 utilizing provincial health administrative data. We measured the proportion of individuals who underwent PA screening via the aldosterone-to-renin ratio by year. We further examined screening rates among patients with hypertension plus OSA by the presence of concurrent hypokalemia and resistant hypertension. Clinical predictors associated with screening were assessed via Cox regression modeling.
The study cohort included 53,130 adults with both hypertension and OSA, of which only 634 (1.2%) underwent PA screening. Among patients with hypertension, OSA, and hypokalemia, the proportion of eligible patients screened increased to 2.8%. Among patients ≥65 years with hypertension, OSA, and prescription of ≥4 antihypertensive medications, the proportion of eligible patients screened was 1.8%. Older age was associated with a decreased likelihood of screening while hypokalemia and subspecialty care with internal medicine, cardiology, endocrinology, or nephrology were associated with an increased likelihood of screening. No associations with screening were identified with sex, rural residence, cardiovascular disease, diabetes, or respirology subspecialty care.
The population-level uptake of the guideline recommendation to screen all patients with hypertension plus OSA for PA is exceedingly low.