Clinical Management of Primary Aldosteronism: An Update.

Autor:	Rossi GP; Internal and Emergency Medicine, Department of Medicine, DIME University of Padua, Italy (G.P.R., C.G., G.R., T.M.S.)., Rossi FB; International PhD Program in Arterial Hypertension and Vascular Biology, University of Rome, 'La Sapienza' Rome, Italy (F.B.R.)., Guarnieri C; Internal and Emergency Medicine, Department of Medicine, DIME University of Padua, Italy (G.P.R., C.G., G.R., T.M.S.)., Rossitto G; Internal and Emergency Medicine, Department of Medicine, DIME University of Padua, Italy (G.P.R., C.G., G.R., T.M.S.)., Seccia TM; Internal and Emergency Medicine, Department of Medicine, DIME University of Padua, Italy (G.P.R., C.G., G.R., T.M.S.).
Jazyk:	angličtina
Zdroj:	Hypertension (Dallas, Tex. : 1979) [Hypertension] 2024 Sep; Vol. 81 (9), pp. 1845-1856. Date of Electronic Publication: 2024 Jul 24.
DOI:	10.1161/HYPERTENSIONAHA.124.22642
Abstrakt:	Despite carrying an excess risk of cardiovascular events, primary aldosteronism (PA) is a commonly overlooked secondary form of arterial hypertension. An increased awareness of its high prevalence and broader screening strategies are urgently needed to improve its detection rate and allow early diagnosis and targeted treatment. For patients with unilateral PA, these measures can correct hyperaldosteronism and ensure cure of hypertension, even when resistant to drug treatment, thus preventing adverse cardiovascular events. Among these, atrial fibrillation is the most common, but left ventricular hypertrophy, stroke, chronic kidney disease, and myocardial infarction also occur more often than in patients with hypertension and no PA. Young patients, who have higher chances of being cured long term, and high-risk patients, such as those with stage III or resistant hypertension, are those who will benefit most from an early diagnosis of PA. Therefore, the implementation of strategies to detect PA by a simplified diagnostic algorithm is necessary. In the patients who seek for surgical cure, adrenal vein sampling is key for the identification of unilateral PA and the achievement of optimal outcomes. Unfortunately, being technically demanding and poorly available, adrenal vein sampling represents the bottleneck in the workup of PA. Considering the novel knowledge generated in the past 5 years in many studies, particularly in the AVIS-2 study (Adrenal Vein Sampling International Study-2), based on 4 decades of experience at our center and on the last guidelines, we herein provide an update on the management of PA with recommendations for drug treatment and strategies to avoid adrenal vein sampling wherever it is poorly, or not, available. Competing Interests: None.
Databáze:	MEDLINE
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