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

Sekundární hypertenze představuje příležitost, jak nabídnout cílenou terapii pacientům s arteriální hypertenzí. Léčba může vést ke zlepšení kompenzace hypertenze a v některých případech i k úplnému vyléčení. Podmínkou pro úspěšnou léčbu je včasná diagnostika, která při vysokém počtu pacientů s arteriální hypertenzí musí být cílená. Nejdůležitější částí v diagnostickém procesu je na možnost sekundární etiologie myslet, a to především ve skupině pacientů s rezistentní hypertenzí a při specifických projevech sekundární hypertenze. Pokud se podezření potvrdí, je vhodné pacienta referovat do specializovaného centra.

Secondary hypertension represents an opportunity to offer targeted therapy to patients with arterial hypertension. The treatment, in some cases, can lead to a complete cure or an improvement in the compensation of hypertension. However, it's crucial to diagnose this early, as in the case of a larger group of patients with hypertension, the diagnostic process must be targeted. The most important when diagnosing is to acknowledge secondary etiology as a possibility, especially in patients with resistant hypertension and specific manifestations of secondary hypertension. If the suspicion is confirmed, we refer the patient to a specialized centre.

• Klíčová slova
• sekundární hypertenze,
• MeSH
• feochromocytom diagnóza   komplikace   MeSH
• hyperaldosteronismus diagnóza   komplikace   MeSH
• hypertenze * diagnóza   etiologie   farmakoterapie   klasifikace   MeSH
• krevní tlak účinky léků   MeSH
• lidé MeSH
• obstrukční spánková apnoe diagnóza   komplikace   MeSH
• renovaskulární hypertenze diagnóza   komplikace   MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: Adrenal venous sampling is recommended for the identification of unilateral surgically curable primary aldosteronism but is often clinically useless, owing to failed bilateral adrenal vein cannulation. OBJECTIVES: To investigate if only unilaterally selective adrenal vein sampling studies can allow the identification of the responsible adrenal. METHODS: Among 1625 patients consecutively submitted to adrenal vein sampling in tertiary referral centers, we selected those with selective adrenal vein sampling results in at least one side; we used surgically cured unilateral primary aldosteronism as gold reference. The accuracy of different values of the relative aldosterone secretion index (RASI), which estimates the amount of aldosterone produced in each adrenal gland corrected for catheterization selectivity, was examined. RESULTS: We found prominent differences in RASI values distribution between patients with and without unilateral primary aldosteronism. The diagnostic accuracy of RASI values estimated by the area under receiver operating characteristic curves was 0.714 and 0.855, respectively, in the responsible and the contralateral side; RASI values >2.55 and ≤0.96 on the former and the latter side furnished the highest accuracy for detection of surgically cured unilateral primary aldosteronism. Moreover, in the patients without unilateral primary aldosteronism, only 20% and 16% had RASI values ≤0.96 and >2.55. CONCLUSIONS: With the strength of a large real-life data set and use of the gold reference entailing an unambiguous diagnosis of unilateral primary aldosteronism, these results indicate the feasibility of identifying unilateral primary aldosteronism using unilaterally selective adrenal vein sampling results. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01234220.

• MeSH
• adrenalektomie MeSH
• aldosteron * MeSH
• hyperaldosteronismus * diagnóza   chirurgie   MeSH
• lidé MeSH
• nadledviny krevní zásobení   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• klinická studie MeSH
• práce podpořená grantem MeSH

• MeSH
• antihypertenziva aplikace a dávkování   klasifikace   MeSH
• diferenciální diagnóza MeSH
• hyperaldosteronismus diagnóza   klasifikace   patologie   terapie   MeSH
• hypertenze indukovaná těhotenstvím farmakoterapie   terapie   MeSH
• hypertenze * diagnóza   klasifikace   patologie   terapie   MeSH
• kardiovaskulární nemoci farmakoterapie   patologie   MeSH
• kombinovaná farmakoterapie MeSH
• krevní tlak MeSH
• léková kontraindikace MeSH
• lidé MeSH
• měření krevního tlaku metody   MeSH
• paragangliom diagnóza   klasifikace   patologie   terapie   MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Primary aldosteronism (PA) is the most frequent form of endocrine hypertension. Recently, frequent clinically significant adrenal insufficiency after adrenalectomy in subjects with PA has been reported, which may make the early postsurgical management difficult. We retrospectively searched for possible adrenal insufficiency in subjects who underwent adrenalectomy for PA and have measured cortisol in the early postoperative course. We included subjects with confirmed diagnosis of PA who underwent either posture testing (blood draw at 06:00 and 08:00) and/or adrenal venous sampling (AVS) (blood draw between 08:00 and 09:00) and have also measured cortisol after surgery (cortisol measured approximately at 07:00). Cortisol was measured by immunoassay. In this study, we identified 150 subjects (age 48.5 ± 10.3 years) with available cortisol values in the early postoperative course (median [25th percentile, 75th percentile]) 6 [5,6] days. Postoperative cortisol values (551 ± 148 nmol/l) were normal and significantly higher, compared to preoperative standing cortisol values (404 ± 150 nmol/l; (P < 0.001) and AVS cortisol values (493 ± 198 nmol/l; P = 0.009), and did not significantly differ from preoperative supine cortisol values. Postsurgical cortisol values were not different among subjects with or without abnormal dexamethasone suppression test or elevated urinary free cortisol pre-surgery, and were significantly higher in subjects with abnormal diurnal cortisol variability compared with subjects with normal diurnal variability. No patient presented with adrenocortical crisis in the later follow-up. In conclusion, postoperative cortisol values did not indicate any suspicion of possible adrenal insufficiency. To exclude possible adrenal insufficiency, it may be sufficient to measure morning cortisol in the early postoperative course.

• MeSH
• adrenalektomie MeSH
• adrenální insuficience * diagnóza   etiologie   chirurgie   MeSH
• dospělí MeSH
• hydrokortison MeSH
• hyperaldosteronismus * komplikace   diagnóza   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

AIMS: We aimed at determining the rate of drug-resistant arterial hypertension in patients with an unambiguous diagnosis of primary aldosteronism (PA). Moreover, we sought for investigating the diagnostic performance of adrenal vein sampling (AVS), and the effect of adrenalectomy on blood pressure (BP) and prior treatment resistance in PA patients subtyped by AVS in major referral centres. METHODS AND RESULTS: The Adrenal Vein Sampling International Study-2 (AVIS-2) was a multicentre international study that recruited consecutive PA patients submitted to AVS, according to current guidelines, during 15 years. The patients were over 18 years old with arterial hypertension and had an unambiguous diagnosis of PA. The rate of resistant hypertension was assessed at baseline and after adrenalectomy using the American Heart Association (AHA) 2018 definition. Information on presence or absence of resistant hypertension was available in 89% of the 1625 enrolled PA patients. Based on the AHA 2018 criteria, resistant hypertension was found in 20% of patients, of which about two-thirds (14%) were men and one-third (6%) women (χ2 = 17.1, P < 1*10-4) with a higher rate of RH in men than in women (23% vs. 15% P < 1*10-4). Of the 292 patients with resistant hypertension, 98 (34%) underwent unilateral AVS-guided adrenalectomy, which resolved BP resistance to antihypertensive treatment in all. CONCLUSIONS: (i) Resistant hypertension is a common presentation in patients seeking surgical cure of PA; (ii) AVS is key for the optimal management of patients with PA due to resistant hypertension; and (iii) AVS-guided adrenalectomy allowed resolution of treatment-resistant hypertension.

• MeSH
• adrenalektomie škodlivé účinky   metody   MeSH
• hyperaldosteronismus * diagnóza   chirurgie   MeSH
• hypertenze * diagnóza   farmakoterapie   epidemiologie   MeSH
• lidé MeSH
• mladiství MeSH
• nadledviny krevní zásobení   chirurgie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• hyperaldosteronismus * diagnóza   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

: Primary aldosteronism is a frequent cause of secondary hypertension requiring a specific pharmacological treatment with mineralocorticoid receptor antagonist or with unilateral adrenalectomy. These treatments have shown to reduce the excess of cardiovascular risk characteristically associated with this disease. In part I of this consensus, we discussed the procedures for the diagnosis of primary aldosteronism. In the present part II, we address the strategies for the differential diagnosis of primary aldosteronism subtypes and therapy. We also discuss the evaluation of outcomes and provide suggestions for follow-up as well as cardiovascular and metabolic complications specifically associated with primary aldosteronism. Finally, we analyse the principal gaps of knowledge and future challenges for research in this field.

• MeSH
• adrenalektomie MeSH
• antagonisté mineralokortikoidních receptorů terapeutické užití   MeSH
• hyperaldosteronismus * komplikace   diagnóza   genetika   terapie   MeSH
• hypertenze etiologie   MeSH
• konsensus MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

: Autonomous aldosterone overproduction represents the underlying condition of 5-10% of patients with arterial hypertension and carries a significant burden of mortality and morbidity. The diagnostic algorithm for primary aldosteronism is sequentially based on hormonal tests (screening and confirmation tests), followed by lateralization studies (adrenal CT scanning and adrenal venous sampling) to distinguish between unilateral and bilateral disease. Despite the recommendations of the Endocrine Society guideline, primary aldosteronism is largely underdiagnosed and undertreated with high between-centre heterogeneity. Experts from the European Society of Hypertension have critically reviewed the available literature and prepared a consensus document constituting two articles to summarize current knowledge on the epidemiology, diagnosis, treatment, and complications of primary aldosteronism.

• MeSH
• aldosteron krev   MeSH
• hyperaldosteronismus * diagnóza   epidemiologie   genetika   MeSH
• hypertenze MeSH
• konsensus MeSH
• lidé MeSH
• prevalence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• hyperaldosteronismus * diagnóza   epidemiologie   MeSH
• hypertenze MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH