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

Autor:	Pintus G; Internal Emergency Medicine Unit, Department of Medicine, Specialized Center for Blood Pressure Disorders-Regione Veneto (G.P., T.M.S., D.B., B.C., G.C., G.R., G.P.R.), University of Padova, Italy.; Department of Translational Medicine, Sapienza University of Rome, Italy (G.P.)., Seccia TM; Internal Emergency Medicine Unit, Department of Medicine, Specialized Center for Blood Pressure Disorders-Regione Veneto (G.P., T.M.S., D.B., B.C., G.C., G.R., G.P.R.), University of Padova, Italy., Amar L; Université Paris Cité, Institut national de la santé et de la recherche médicale (INSERM) UMRS 970 and CIC1418, France (L.A., M.A.).; Assistance Publique-Hopitaux De Paris Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (L.A., M.A.)., Azizi M; Université Paris Cité, Institut national de la santé et de la recherche médicale (INSERM) UMRS 970 and CIC1418, France (L.A., M.A.).; Assistance Publique-Hopitaux De Paris Hôpital Européen Georges Pompidou, Hypertension Unit, Paris, France (L.A., M.A.)., Riester A; Department of Medicine IV, Ludwig Maximilian University of Munich (LMU) University Hospital, LMU Munich (A.R., M.R.)., Reincke M; Department of Medicine IV, Ludwig Maximilian University of Munich (LMU) University Hospital, LMU Munich (A.R., M.R.)., Widimský J; 3 Department of Medicine (J.W., Z.K.), 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic.; Department of Endocrinology and Metabolism (J.W., Z.K.), 1 Faculty of Medicine and General University Hospital, Prague, Czech Republic., Naruse M; Department of Endocrinology, Clinical Research Institute, National Hospital Organization Kyoto Medical Center and Endocrine Center, Ijinkai Takeda General Hospital, Japan (M.N.)., Kocjan T; University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Slovenia (T.K.)., Negro A; Internal Medicine and Hypertension Center, Ospedale Sant'Anna di Castelnovo Ne' Monti (A.N.).; Azienda Unità sanitaria locale - Istituti di Ricovero e Cura a Carattere Scientifico - (ULS-IRCCS) di Reggio Emilia, Italy (A.N.)., Kline G; University of Calgary, Foothills Medical Centre, Canada (G.K.)., Tanabe A; Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan (A.T.)., Satoh F; Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai (F.S.)., Rump LC; Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany (L.C.R., O.V.)., Vonend O; Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany (L.C.R., O.V.)., Fuller PJ; Monash Health, Clayton, VIC, Australia (P.J.F., J.Y., N.Y.N.C.)., Yang J; Monash Health, Clayton, VIC, Australia (P.J.F., J.Y., N.Y.N.C.)., Chee NYN; Monash Health, Clayton, VIC, Australia (P.J.F., J.Y., N.Y.N.C.)., Magill SB; Medical College of Wisconsin, Endocrinology Center, North Hills Health Center, Menomonee Falls, WI (S.B.M.)., Shafigullina Z; Department of Endocrinology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia (Z.S.)., Quinkler M; Endocrinology in Charlottenburg, Berlin, Germany (M.Q.)., Oliveras A; Hypertension Unit, Nephrology Department, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain (A.O.)., Lee BC; Department of Medical Imaging, National Taiwan University Hospital, Taipei (B.-C.L., C.-C.C.)., Chang CC; Department of Medical Imaging, National Taiwan University Hospital, Taipei (B.-C.L., C.-C.C.).; National Taiwan University College of Medicine, Taipei (C.-C.C.)., Wu VC; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (V.-C.W.)., Krátká Z; 3 Department of Medicine (J.W., Z.K.), 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic.; Department of Endocrinology and Metabolism (J.W., Z.K.), 1 Faculty of Medicine and General University Hospital, Prague, Czech Republic., Battistel M; Hypertension Unit, Nephrology Department, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain (A.O.)., Bagordo D; Internal Emergency Medicine Unit, Department of Medicine, Specialized Center for Blood Pressure Disorders-Regione Veneto (G.P., T.M.S., D.B., B.C., G.C., G.R., G.P.R.), University of Padova, Italy., Caroccia B; Internal Emergency Medicine Unit, Department of Medicine, Specialized Center for Blood Pressure Disorders-Regione Veneto (G.P., T.M.S., D.B., B.C., G.C., G.R., G.P.R.), University of Padova, Italy., Ceolotto G; Internal Emergency Medicine Unit, Department of Medicine, Specialized Center for Blood Pressure Disorders-Regione Veneto (G.P., T.M.S., D.B., B.C., G.C., G.R., G.P.R.), University of Padova, Italy., Rossitto G; Internal Emergency Medicine Unit, Department of Medicine, Specialized Center for Blood Pressure Disorders-Regione Veneto (G.P., T.M.S., D.B., B.C., G.C., G.R., G.P.R.), University of Padova, Italy., Rossi GP; Internal Emergency Medicine Unit, Department of Medicine, Specialized Center for Blood Pressure Disorders-Regione Veneto (G.P., T.M.S., D.B., B.C., G.C., G.R., G.P.R.), University of Padova, Italy.
Jazyk:	angličtina
Zdroj:	Hypertension (Dallas, Tex. : 1979) [Hypertension] 2024 Jun; Vol. 81 (6), pp. 1391-1399. Date of Electronic Publication: 2024 Mar 25.
DOI:	10.1161/HYPERTENSIONAHA.124.22721
Abstrakt:	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 β-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. Competing Interests: Disclosures None.
Databáze:	MEDLINE
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