Primary and "Pre-Primary" Aldosteronism in Resistant Hypertension: A Practical, Pragmatic, and Prudent Approach in Resource-Limited Milieu.

Autor: Garg Y; Endocrinology, Diabetes and Metabolism, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Bangalore, IND., Vaishnav MS; Endocrinology, Diabetes and Metabolism, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Bangalore, IND., Garg N; Endocrinology, Diabetes and Metabolism, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Bangalore, IND., Vijay RB; Endocrinology, Diabetes and Metabolism, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Bangalore, IND., Lekkala L; Endocrinology, Diabetes and Metabolism, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Bangalore, IND., Dinesha S; Endocrinology, Diabetes and Metabolism, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Bangalore, IND., Ravikumar P; Endocrinology, Diabetes and Metabolism, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Bangalore, IND., Kamala T; Endocrinology, Diabetes and Metabolism, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Bangalore, IND., Muniraj K; Endocrinology, Diabetes and Metabolism, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Bangalore, IND., Srikanta S; Endocrinology, Diabetes and Metabolism, Samatvam Endocrinology Diabetes Center, Samatvam: Science and Research for Human Welfare Trust, Bangalore, IND.
Jazyk: angličtina
Zdroj: Cureus [Cureus] 2024 Oct 22; Vol. 16 (10), pp. e72161. Date of Electronic Publication: 2024 Oct 22 (Print Publication: 2024).
DOI: 10.7759/cureus.72161
Abstrakt: Introduction Primary aldosteronism (PA), once considered rare, is now recognized as the most common cause of secondary hypertension, accounting for almost a quarter of resistant hypertension (RH) cases. Despite this, PA remains underdiagnosed, with an extremely low percentage of RH patients undergoing screening. Methods In a specialty diabetes-endocrinology clinic, the aldosterone:renin ratio (ARR) was assessed in 115 consecutive RH patients (ages 21-93 years; 47% male; 87% with type 2 diabetes). Fasting blood samples were drawn in a standing position after 30 minutes of walking. Adrenal imaging (CT/MRI) was performed for those with an ARR >20. Results ARR values ranged from 0.4 to 227 (ARR <10 (35%); 11-20 (19%), 21-40 (25%), and >40 (21%)), with corresponding stepwise decreasing plasma renin activity (PRA) (P= 1E-6) and increasing serum aldosterone (SA) (P= 8E-7). Increasing ARR tended to be associated with an increase in serum creatinine (R= 0.23; P= 0.03) and a decrease in estimated glomerular filtration rate (eGFR) (R= -0.24; P= 0.02) and an increase in urine albumin: creatinine ratio. The ARR> 40 group displayed the highest serum creatinine, lowest eGFR, higher urine albumin: creatinine ratio, highest serum sodium, lowest serum potassium, and highest (44%) abnormal adrenal imaging (bilateral hyperplasia diffuse/nodular; solitary adenoma), reflecting a later stage of the pathological spectrum. PA treatment with mineralocorticoid receptor antagonists (MRAs) had a salutary effect. Conclusions Our observations further reinforce that PA is not a binary condition, but exists as a spectrum disorder responsive to MRAs, even in patients with mildly elevated or normal aldosterone levels. Early disease detection/recognition ("renin-independent aldosterone production") can be facilitated by marking "pre-primary" aldosteronism (ARR 11-20), followed by monitoring progression (periodic rescreening) and optimizing treatment, with hopeful mitigation of end-organ damage in RH.
Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Science for Health issued approval reference number 2022-10-06-01, dated October 22, 2022. Written informed consent was deemed as not necessary as the study involved retrospective data analysis – medical record review only. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
(Copyright © 2024, Garg et al.)
Databáze: MEDLINE