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Subtype Identification of Surgically Curable Primary Aldosteronism During Treatment With Mineralocorticoid Receptor Blockade
G. Pintus, TM. Seccia, L. Amar, M. Azizi, A. Riester, M. Reincke, J. Widimský, M. Naruse, T. Kocjan, A. Negro, G. Kline, A. Tanabe, F. Satoh, LC. Rump, O. Vonend, PJ. Fuller, J. Yang, NYN. Chee, SB. Magill, Z. Shafigullina, M. Quinkler, A....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články
NLK
Free Medical Journals
od 1979 do Před 1 rokem
Open Access Digital Library
od 1979-01-01
Open Access Digital Library
od 1979-01-01
- MeSH
- adrenalektomie metody MeSH
- aldosteron krev MeSH
- antagonisté mineralokortikoidních receptorů * terapeutické užití MeSH
- dospělí MeSH
- hyperaldosteronismus * krev diagnóza farmakoterapie chirurgie MeSH
- krevní tlak fyziologie účinky léků MeSH
- lidé středního věku MeSH
- lidé MeSH
- nadledviny * MeSH
- renin krev MeSH
- retrospektivní studie MeSH
- studie případů a kontrol MeSH
- tendenční skóre MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
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.
Azienda Unità sanitaria locale Istituti di Ricovero e Cura a Carattere Scientifico
Department of Medical Imaging National Taiwan University Hospital Taipei
Department of Medicine 1st Faculty of Medicine and General University Hospital Prague Czech Republic
Department of Medicine 4 Ludwig Maximilian University of Munich
Department of Nephrology Endocrinology and Vascular Medicine Tohoku University Hospital Sendai
Department of Translational Medicine Sapienza University of Rome Italy
Endocrinology in Charlottenburg Berlin Germany
Hypertension Unit Nephrology Department Hospital del Mar Universitat Pompeu Fabra Barcelona Spain
Internal Medicine and Hypertension Center Ospedale Sant'Anna di Castelnovo Ne' Monti
Medical College of Wisconsin Endocrinology Center North Hills Health Center Menomonee Falls WI
Monash Health Clayton VIC Australia
National Taiwan University College of Medicine Taipei
Université Paris Cité Institut national de la santé et de la recherche médicale
University Medical Centre Ljubljana Faculty of Medicine University of Ljubljana Slovenia
Citace poskytuje Crossref.org
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- $a Pintus, Giovanni $u 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 $u Department of Translational Medicine, Sapienza University of Rome, Italy (G.P.) $1 https://orcid.org/0000000231895850
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