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.

• 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

Purpose: Primary aldosteronism (PA) is considered the most common form of secondary hypertension, however, its prevalence, particularly in a general population, is still a matter of debate. The aim of our study was to evaluate the prevalence of PA in a randomly selected general population sample.Materials and methods: A total of 1940 individuals (1% population random sample) aged 25-64 years were screened for major cardiovascular risk factors in six districts of the Czech Republic. Hypertension was defined as a mean of two blood pressure readings ≥140/90 mmHg at one visit or taking antihypertensive medication. Within this population, 740 individuals were labelled as hypertensives and 650 of them sampled for the analysis of direct plasma renin and serum aldosterone. The diagnosis of PA was based on elevated serum aldosterone, low plasma renin and high aldosterone/renin (ARR) ratio and was also verified by a confirmatory test with saline infusion.Results: Positive ARR was found in 52 (8%) individuals (64% women, 36% men, however, due to substatntial proportion of reluctatnt participants to undergo a further work-up (27%), we could confirm the diagnosis of PA only in 13 of them (2%). Aldosterone-producing adenoma was found in one case only, seven patients had idiopathic type and five individuals refused potential surgical treatment therefore, adrenal venous sampling was not performed.Conclusion: Elevated serum aldosterone together with low renin and high ARR were found in 52 (8%) of hypertensives selected from a general population sample, however, the diagnosis of PA was confirmed only in 13 of them (2%). This study based on a general population survey highlighted the difficulty of conducting epidemiological studies on primary aldosteronism in a relatively healthy cohort part of whom did not provide the level of collaboration that is necessary to assess the true prevalence of this condition.

• MeSH
• aldosteron krev   MeSH
• antihypertenziva terapeutické užití   MeSH
• biologické markery krev   MeSH
• dospělí MeSH
• hyperaldosteronismus krev   diagnóza   epidemiologie   MeSH
• hypertenze diagnóza   farmakoterapie   epidemiologie   patofyziologie   MeSH
• krevní tlak účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prevalence MeSH
• průřezové studie MeSH
• renin krev   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

Intradialytic hypotension is a major complication during hemodialysis session, associated with increased risk of cardiovascular events and mortality. Its pathophysiology is believed to be multifactorial and remains not well elucidated. The aim of this study is to put forward new mechanisms behind the development of intradialytic hypotension. The study included sixty-five subjects on chronic hemodialysis, divided into two groups: intradialytic hypotensive (n=12) and normotensive (n=53), according to the variation of systolic blood pressure between post-dialysis and pre-dialysis measurements. Renin and angiotensin converting enzyme I plasma concentrations increased in both groups but more likely in normotensive group. Aldosterone plasma concentration is increased in the normotensive group while it decreased in the intradialytic hypotension group. Plasma endothelin concentrations showed higher values in intradialytic hypotension group. Post-dialysis asymmetric dimethylarginine and angiotensin converting enzyme 2 plasma concentrations were significantly higher in intradialytic hypotension group as compared to normotensive one. Collectrin plasma concentrations were significantly lower in intradialytic hypotension group. Finally, post-dialysis vascular endothelial growth factor C plasma concentration significantly increased in intradialytic hypotension group. In conclusion, endothelial dysfunction characterized by a lower level of vasoactive molecule seems to play a critical role in intradialytic hypotension development.

• MeSH
• aldosteron krev   MeSH
• arginin analogy a deriváty   krev   MeSH
• biologické markery krev   MeSH
• časové faktory MeSH
• cévní endotel metabolismus   patofyziologie   MeSH
• dialýza ledvin škodlivé účinky   MeSH
• endotelin-1 krev   MeSH
• hypotenze etiologie   krev   patofyziologie   MeSH
• inhibitory ACE krev   MeSH
• krevní tlak * MeSH
• lidé středního věku MeSH
• lidé MeSH
• membránové glykoproteiny krev   MeSH
• nemoci ledvin krev   patofyziologie   terapie   MeSH
• renin krev   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• vaskulární endoteliální růstový faktor C krev   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Exercise is a stress stimulus for the human organism affecting the homeostatic mechanisms of the body, depending on the type, duration, intensity and frequency of exercise. The aim of this study was to determine the effects of a moderate aerobic exercise bout on the Hypothalamo-Pituitary-Adrenal (HPA) axis acute hormonal responses in healthy adult humans. Twelve healthy male and female volunteers (age: 30.6 ± 4.4 years), performed a single bout of a 30-minute aerobic exercise at 70% of VO2max on a treadmill, following standard diet. Blood samples were collected before (t0), at the end of the exercise bout (t30), and 30 min after the completion of exercise (t60). Serum adrenocorticotropic hormone (ACTH), cortisol (COR), aldosterone (ALDO) and renin (REN) were measured. One-way ANOVA was used for statistics. ACTH and COR decreased after exercise, reaching significance (p < 0.01) 30 min after the completion of the exercise bout. ALDO increased at the end of exercise and remained elevated 30 min after its completion. REN significantly increased at the end of exercise (p < 0.05) and remained elevated. The exercise regimen used in this study had beneficial effects on the stress axis, suggesting that specific exercise protocols can be characterised by mild physiological stress-inducing effects hence be prescribed for special diseased populations.

• MeSH
• adrenokortikotropní hormon krev   MeSH
• aldosteron krev   MeSH
• cvičení * fyziologie   MeSH
• dospělí MeSH
• fyziologický stres MeSH
• hydrokortison krev   MeSH
• kardiorespirační zdatnost fyziologie   MeSH
• lidé MeSH
• renin-angiotensin systém fyziologie   MeSH
• renin krev   MeSH
• systém hypotalamus-hypofýza fyziologie   MeSH
• zátěžový test metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

Ivabradine, the selective inhibitor of the If current in the sinoatrial node, exerts cardiovascular protection by its bradycardic effect and potentially pleiotropic actions. However, there is a shortage of data regarding ivabradine's interaction with the renin-angiotensin-aldosterone system (RAAS). This study investigated whether ivabradine is able to protect a hypertensive heart in the model of L-NAME-induced hypertension and to interfere with the RAAS. Four groups (n = 10/group) of adult male Wistar rats were treated as follows for four weeks: control, ivabradine (10 mg/kg/day), L-NAME (40 mg/kg/day), and L-NAME plus ivabradine. L-NAME administration increased systolic blood pressure (SBP) and left ventricular (LV) weight, enhanced hydroxyproline concentration in the LV, and deteriorated the systolic and diastolic LV function. Ivabradine reduced heart rate (HR) and SBP, and improved the LV function. The serum concentrations of angiotensin Ang 1−8 (Ang II), Ang 1−5, Ang 1−7, Ang 1−10, Ang 2−8, and Ang 3−8 were decreased in the L-NAME group and ivabradine did not modify them. The serum concentration of aldosterone and the aldosterone/Ang II ratio were enhanced by L-NAME and ivabradine reduced these changes. We conclude that ivabradine improved the LV function of the hypertensive heart in L-NAME-induced hypertension. The protective effect of ivabradine might have been associated with the reduction of the aldosterone level.

• MeSH
• aldosteron krev   MeSH
• angiotensiny krev   MeSH
• biologické markery MeSH
• echokardiografie MeSH
• funkce levé komory srdeční účinky léků   MeSH
• hydroxyprolin krev   metabolismus   MeSH
• hypertenze diagnóza   etiologie   metabolismus   patofyziologie   MeSH
• ivabradin farmakologie   MeSH
• kardiovaskulární látky farmakologie   MeSH
• kolagen metabolismus   MeSH
• krevní tlak účinky léků   MeSH
• krysa rodu rattus MeSH
• modely nemocí na zvířatech MeSH
• NG-nitroargininmethylester škodlivé účinky   MeSH
• renin-angiotensin systém účinky léků   MeSH
• renin krev   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

hypertoniků. Bývá spojen nejen s těžkou až farmakorezistentní hypertenzí, výskytem hypokalemie, ale také se zvýšenou kardiovaskulární morbiditou. Základním screeningovým vyšetřením je poměr aldosteronu k plazmatickému reninu, po kterém následuje potvrzení nálezu konfirmačními testy, separovanými odběry a morfologickým zobrazením. Při nálezu jednostranného postižení je doporučena laparoskopická adrenalektomie. Při oboustranném postižení nebo pokud si pacient operační výkon nepřeje, je základní léčbou farmakoterapie blokátorem mineralokortikoidního receptoru spironolaktonem. Časná diagnostika a léčba primárního hyperaldosteronizmu nejen zlepšuje kontrolu kalemie a krevního tlaku, ale také může zabránit rozvoji kardiovaskulárních komplikací.

Primary aldosteronism (PA), the most common cause of secondary hypertension, is reported in 4.3% of hypertensive patients. It is caused by the overproduction of aldosterone due to an adrenal disorder. Primary aldosteronism is associated with resistant hypertension, hypokalaemia and increased cardiovascular morbidity. Primary aldosteronism is diagnosed through a multistep procedure, beginning with measurement of the aldosterone-to-renin ratio, a basic screening test. Then confirmatory tests, the collection of blood samples and morphologic imaging need to be performed. A unilateral laparoscopic adrenalectomy for patients with documented unilateral primary aldosteronism is recommended. Medical treatment with a mineralocorticoid receptor (MR) antagonist (spironolactone) is recommended for patients with PA due to a bilateral adrenal disease or patients unwilling or unable to undergo surgery. Early diagnostics and treatment of the PA may resolve hypokalaemia, lower the blood pressure and reverse the cardiovascular morbidity caused by the aldosterone excess.

• MeSH
• adrenalektomie metody   MeSH
• aldosteron analýza   krev   MeSH
• antagonisté mineralokortikoidních receptorů terapeutické užití   MeSH
• diagnostické techniky a postupy MeSH
• hyperaldosteronismus * diagnóza   farmakoterapie   chirurgie   komplikace   MeSH
• hypertenze * etiologie   terapie   MeSH
• lidé MeSH
• renin analýza   krev   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Unilateral primary aldosteronism is the most common surgically correctable form of endocrine hypertension and is usually differentiated from bilateral forms by adrenal venous sampling (AVS) or computed tomography (CT). Our objective was to compare clinical and biochemical postsurgical outcomes of patients with unilateral primary aldosteronism diagnosed by CT or AVS and identify predictors of surgical outcomes. Patient data were obtained from 18 internationally distributed centers and retrospectively analyzed for clinical and biochemical outcomes of adrenalectomy of patients with surgical management based on CT (n=235 patients, diagnosed from 1994-2016) or AVS (526 patients, diagnosed from 1994-2015) using the standardized PASO (Primary Aldosteronism Surgical Outcome) criteria. Biochemical outcomes were highly different according to surgical management approach with a smaller proportion in the CT group achieving complete biochemical success (188 of 235 [80%] patients versus 491 of 526 [93%], P<0.001) and a greater proportion with absent biochemical success (29 of 235 [12%] versus 10 of 526 [2%], P<0.001). A diagnosis by CT was associated with a decreased likelihood of complete biochemical success compared with AVS (odds ratio, 0.28; 0.16-0.50; P<0.001). Clinical outcomes were not significantly different, but the absence of a postsurgical elevated aldosterone-to-renin ratio was a strong marker of complete clinical success (odds ratio, 14.81; 1.76-124.53; P=0.013) in the CT but not in the AVS group. In conclusion, patients diagnosed by CT have a decreased likelihood of achieving complete biochemical success compared with a diagnosis by AVS.

• MeSH
• adrenalektomie metody   MeSH
• aldosteron krev   MeSH
• biologické markery krev   MeSH
• dospělí MeSH
• hodnocení výsledků zdravotní péče metody   statistika a číselné údaje   MeSH
• hyperaldosteronismus krev   diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nadledviny krevní zásobení   MeSH
• odběr vzorku krve metody   MeSH
• počítačová rentgenová tomografie metody   MeSH
• renin krev   MeSH
• retrospektivní studie MeSH
• vény MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

Vitamin D deficiency is a major health problem in the Saudi population. A negative association between blood pressure and vitamin D level has been suggested in several clinical and epidemiological studies and evidence for an effect of vitamin D in lowering blood pressure was reported. These findings indicate that 1,25(OH)2D3 deficiency may play a role in the pathogenesis of hypertension through its effect on the renin-angiotensin system. We are the first to investigate the correlation between blood pressure or renin concentration and vitamin D status in the Saudi population METHODS: we included 201 healthy Saudi premenopausal females (20-45 years old). Blood pressure was measured by a standardized method using an automated blood pressure monitor (BPTru). Fasting blood samples were collected from each participant after 20 minutes of rest in the seated position. Serum cholicalciferol, PTH and renin concentration were measured by sandwich chemiluminescence immunoassay method (DiaSorin, Italy). RESULTS: The analysis included 192 subjects who were normotensive (blood pressure <140/90 mmHg). A total of 34% of women had a severe deficiency (vitamin D ≤ 12.5 nmol/L); 41% had moderate deficiency (vitamin D levels between 12.5 - 25 nmol/L); 23% had mild deficiency (vitamin D level ≥ 25 - < 50 nmol/L); and 2% had insufficiency (vitamin D level ≥ 50 - ≤ 75 nmol/L). None had a sufficient level of ≥75 nmol/L. The systolic blood pressure ranged from 79-130.5 mmHg and the diastolic from 48.5-85.5 mmHg. Both systolic and diastolic blood pressures were significantly higher in women that were in the lower 2 quartiles of vitamin D. However, linear regression analysis adjusting for potential confounders showed that 25(OH)D level was not a predictor of either systolic or diastolic blood pressures. A negative correlation (although not significant) was found between vitamin D level and plasma renin concentration in this study group. CONCLUSION: Vitamin D deficiency was highly prevalent among the study group. Vitamin D was a not a predictor of either systolic or diastolic blood pressure. There was a negative correlation between vitamin D level and renin concentration although not statically significant. It is possible that any underlying relationship was obscured by the relatively young age group or due to the narrow blood pressure range of the studied population. A larger sample size including hypertensive subjects may be needed.

• MeSH
• dospělí MeSH
• krevní tlak * fyziologie   MeSH
• lidé MeSH
• lineární modely MeSH
• mladý dospělý MeSH
• nedostatek vitaminu D * epidemiologie   krev   MeSH
• premenopauza MeSH
• průřezové studie MeSH
• renin krev   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH

The aim of the present study was to test the hypothesis that chronic hypoxia would aggravate hypertension in Ren-2 transgenic rats (TGR), a well-defined monogenetic model of hypertension with increased activity of endogenous renin-angiotensin system (RAS). Systolic blood pressure (SBP) in conscious rats and mean arterial pressure (MAP) in anesthetized TGR and normotensive Hannover Sprague-Dawley (HanSD) rats were determined under normoxia that was either continuous or interrupted by two weeks ́ hypoxia. Expression, activities and concentrations of individual components of RAS were studied in plasma and kidney of TGR and HanSD rats under normoxic conditions and after exposure to chronic hypoxia. In HanSD rats two weeks ́ exposure to chronic hypoxia did not alter SBP and MAP. Surprisingly, in TGR it decreased markedly SBP and MAP; this was associated with substantial reduction in plasma and kidney renin activities and also of angiotensin II (ANG II) levels, without altering angiotensin-converting enzyme (ACE) activities. Simultaneously, in TGR the exposure to hypoxia increased kidney ACE type 2 (ACE2) activity and angiotensin 1-7 (ANG 1-7) concentrations as compared with TGR under continuous normoxia. Based on these results, we propose that suppression of the hypertensiogenic ACE-ANG II axis in the circulation and kidney tissue, combined with augmentation of the intrarenal vasodilator ACE2-ANG 1-7 axis, is the main mechanism responsible for the blood pressure-lowering effects of chronic hypoxia in TGR.

• MeSH
• angiotensin I krev   MeSH
• angiotensin II krev   MeSH
• angiotensin konvertující enzym krev   MeSH
• hypertenze krev   genetika   patofyziologie   prevence a kontrola   MeSH
• hypoxie komplikace   enzymologie   patofyziologie   MeSH
• krevní tlak MeSH
• ledviny enzymologie   MeSH
• modely nemocí na zvířatech MeSH
• peptidové fragmenty krev   MeSH
• potkani Sprague-Dawley MeSH
• potkani transgenní MeSH
• protoonkogenní proteiny krev   MeSH
• receptory spřažené s G-proteiny krev   MeSH
• renin-angiotensin systém * MeSH
• renin krev   genetika   MeSH
• signální transdukce MeSH
• vazodilatace * MeSH
• vazokonstrikce * MeSH
• věkové faktory MeSH
• zvířata MeSH
• Check Tag
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Primární hyperaldosteronizmus (PH) je nejčastější příčinou nejen endokrinní, ale i sekundární hypertenze vyvolané autonomní nadprodukcí aldosteronu kůrou nadledvin. PH je typicky charakterizován hypertenzí, hypokalemií, zvýšeným poměrem aldosteron/renin díky zvýšeným koncentracím aldosteronu a nízkým hladinám reninu a chyběním suprese aldosteronu v průběhu konfirmačních testů. Laboratorní diagnostika PH může však být svízelná, neboť hypokalemie se vyskytuje pouze u asi 50 % případů a vyšetřování parametrů osy renin-angiotenzin-aldosteron může být ovlivněno celou řadou faktorů, ke kterým je třeba přihlédnout. Morfologická diagnostika PH bývá rovněž svízelná díky malé velikosti nádorů/hyperplazií a ve většině případů je nutné provést katetrizaci suprarenálních žil s cílenými separovanými odběry na hormonální testy. Díky relativně vysoké prevalenci PH v populaci hypertoniků (5–11 %) a možnosti trvalého vyléčení u části pacientů je nezbytná časná diagnostika s přesným odlišením jednotlivých forem PH a brzkým zahájením specifické terapie (konzervativní vs chirurgická). Díky četným úskalím diagnostických a léčebných přístupů by každý pacient s podezřením na PH měl býti vyšetřen ve specializovaném hypertenzním centru.

Primary hyperaldosteronism (PH) is common cause of endocrine/secondary hypertension with autonomous aldo­sterone overproduction by adrenal cortex. PH is typically characterized by hypertension, hypokalemia, high plasma aldosterone/renin ratio, high aldosterone, suppressed renin and nonsupressibilty of aldosterone during confirmatory tests. Diagnosis of PH can be difficult since hypokalemia is found only in 50 % of cases and measurement of the parameters of renin-angiotensin-aldosterone system can be influenced by several factors. Morphological dia­gnosis requires in majority of cases adrenal venous sampling. Early diagnostic and therapeutic measures are very important due to high prevalence of PH and potential cure. Patients with suspicion to PH should be investigated in experienced hypertensive centers due to relatively difficult laboratory and morphological diagnostic approaches.

• Klíčová slova
• sekundární hypertenze,
• MeSH
• aldosteron krev   MeSH
• algoritmy MeSH
• hyperaldosteronismus * diagnóza   krev   terapie   MeSH
• hypertenze etiologie   MeSH
• klinické laboratorní techniky MeSH
• lidé MeSH
• metody pro podporu rozhodování MeSH
• renin krev   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH