BACKGROUND Primary hyperaldosteronism(PH)is considered to contribute to increased risk of developing type 2 diabetes mellitus(T2DM)and prediabetes.Both PH and DM are associated with increased risk for hypertension,car...BACKGROUND Primary hyperaldosteronism(PH)is considered to contribute to increased risk of developing type 2 diabetes mellitus(T2DM)and prediabetes.Both PH and DM are associated with increased risk for hypertension,cardiovascular diseases,and chronic kidney diseases.However,data on prevalence of T2DM and prediabetes in PH,and impact of T2DM and prediabetes on presentation and cardio renal complications in PH at presentation is sparse.AIM To determine the prevalence of T2DM and prediabetes in PH at diagnosis and impact on presentation and complications of PH.METHODS A retrospective cohort study was conducted in tertiary care settings in individuals with confirmed diagnosis of PH at presentation.Demographic variables,clinical presentations,duration and degree of hypertension,complications,laboratory parameters including sodium,potassium levels,plasma aldosterone concentration(PAC),plasma renin activity(PRA),and aldosterone to renin ratio(ARR)and cardio-renal parameters were collected.Comparison was done between three groups:PH with no DM(Group A)or with pre-diabetes(Group B)or with T2DM(Group C).P<0.05 was statistically significant.RESULTS Among 78 individuals with confirmed PH,62%had pre-diabetes or diabetes;with 37%having DM.Mean duration of T2DM was 5.97±4.7 years.The mean levels of glycaemic parameters among the group A vs B vs C individuals were fasting plasma glucose(mg/dL):87.9±6.5,105.4±9.02,130.6±21.1;post prandial plasma glucose(mg/dL):122.7±9.8,154.9±14,196.7±38.0;glycated haemoglobin(%)(5.3±0.2,5.9±0.2,7.5±0.6,P<0.05),respectively.There was no significant difference in the biochemical parameters(PAC,PRA,ARR,sodium,potassium levels),presentation and complications between the groups.Cardio renal parameters or degree and duration of hypertension were comparable between the groups.CONCLUSION Significant prevalence of T2DM and prediabetes in PH at diagnosis does not impact its presentation or complications.Early screening for undetected PH in T2DM and prediabetes subjects with hypertension may prevent complications.展开更多
Background:Since the diagnostic value of aldosterone to renin ratio(ARR)calculated by plasma renin concentration(PRC)or plasma renin activity(PRA)is still inconclusive,we conducted a meta-analysis by systematically re...Background:Since the diagnostic value of aldosterone to renin ratio(ARR)calculated by plasma renin concentration(PRC)or plasma renin activity(PRA)is still inconclusive,we conducted a meta-analysis by systematically reviewing relevant literature to explore the difference in the diagnostic efficacy of ARR calculated by PRC or PRA,so as to provide guidance for clinical diagnosis.Methods:We searched PubMed,Embase,and Cochrane Library from the establishment of the database to March 2021.We included studies that report the true positive,false positive,true negative,and false negative values for the diagnosis of primary aldosteronism,and we excluded duplicate publications,research without full text,incomplete information,or inability to conduct data extraction,animal experiments,reviews,and systematic reviews.STATA 15.1 was used to analyze the data.Results:The pooled results showed that ARR(plasma aldosterone concentration[PAC]/PRC)had a sensitivity of 0.82(95%confidence interval[CI]:0.78-0.86),a specificity of 0.94(95%CI:0.92-0.95),a positive-likelihood ratio(LR)of 12.77(95%CI:7.04-23.73),a negative LR of 0.11(95%CI:0.07-0.17),and symmetric area under the curve(SAUC)of 0.982,respectively.Furthermore,the diagnostic odds ratio(DOR)of ARR(PAC/PRC)was 180.21.Additionally,the pooled results showed that ARR(PAC/PRA)had a sensitivity of 0.91(95%CI:0.86-0.95),a specificity of 0.91(95%CI:0.90-0.93),a positive LR of 7.30(95%CI:2.99-17.99),a negative LR of 0.10(95%CI:0.04-0.26),and SAUC of 0.976,respectively.The DOR of ARR(PAC/PRA)was 155.52.Additionally,we conducted a subgroup analysis for the different thresholds(<35 or≥35)of PAC/PRC.The results showed that the DOR of the cut-off≥35 groups was higher than the cut-off<35 groups(DOR=340.15,95%CI:38.32-3019.66;DOR=116.40,95%CI=23.28-581.92).Conclusions:The research results suggest that the determination of ARR(PAC/PRC)and ARR(PAC/PRA)was all effective screening tools for PA.The diagnostic accuracy and diagnostic value of ARR(PAC/PRC)are higher than ARR(PAC/PRA).In addition,within a certain range,the higher the threshold,the better the diagnostic value.展开更多
背景醛固酮过多是导致心肌肥厚、心力衰竭和肾功能受损的重要危险因素,导致心脏、肾脏等高血压靶器官损害更为严重。除原醛症外,临床发现部分原发性高血压患者的血浆肾素活性及血醛固酮水平升高,但目前关于原发性高血压患者血压水平与...背景醛固酮过多是导致心肌肥厚、心力衰竭和肾功能受损的重要危险因素,导致心脏、肾脏等高血压靶器官损害更为严重。除原醛症外,临床发现部分原发性高血压患者的血浆肾素活性及血醛固酮水平升高,但目前关于原发性高血压患者血压水平与血浆肾素活性、醛固酮水平的相关性研究偏少,研究结论也不一致。目的分析原发性高血压患者血压水平与肾素-醛固酮系统活性的相关性,探讨伴高醛固酮血症的原发性高血压患者可能的病理生理机制,为此类患者的早期治疗、延缓高血压靶器官损害提供理论依据。方法检索Pub Med、EMBase、中国知网、维普网和万方数据知识服务平台,检索时限为建库至2020年1月。2名研究者根据文献纳入和排除标准独立筛选文献、提取资料并使用纽卡斯尔-渥太华质量评估量表(NOS)进行质量评价。采用Rev Man 5.2软件进行Meta分析。结果以中国高血压人群为研究对象,共纳入16篇文献、原发性高血压患者1885例、健康对照者1438例。NOS偏倚风险评价结果显示16篇文献评分均在5分以上。Meta分析结果显示:试验组的血浆肾素活性[MD=0.40,95%CI(0.04,0.76)]、血浆醛固酮水平[MD=60.03,95%CI(22.28,97.79)]高于对照组(P<0.05)。但试验组的卧位肾素活性[MD=-1.27,95%CI(-1.37,-1.16)]和立位肾素活性[MD=-1.67,95%CI(-1.88,-1.46)]均低于对照组(P<0.05)。试验组卧位醛固酮水平[MD=0.07,95%CI(0.06,0.09)]、立位醛固酮水平[MD=0.22,95%CI(0.05,0.39)]高于对照组(P<0.05)。结论(1)原发性高血压患者的血浆肾素活性、醛固酮水平与血压正常者相比是有差异的。无论是卧位采血还是立位采血,原发性高血压患者的血浆肾素水平是低于血压正常者的,而醛固酮水平是高于血压正常者的。(2)在部分原发性高血压患者中,肾素活性与醛固酮水平变化方向不一致,提示原发性高血压患者的高醛固酮血症系非肾素依赖性的不适当醛固酮水平增高。在降压药物的选择中,应包含盐皮质激素受体拮抗剂。展开更多
文摘BACKGROUND Primary hyperaldosteronism(PH)is considered to contribute to increased risk of developing type 2 diabetes mellitus(T2DM)and prediabetes.Both PH and DM are associated with increased risk for hypertension,cardiovascular diseases,and chronic kidney diseases.However,data on prevalence of T2DM and prediabetes in PH,and impact of T2DM and prediabetes on presentation and cardio renal complications in PH at presentation is sparse.AIM To determine the prevalence of T2DM and prediabetes in PH at diagnosis and impact on presentation and complications of PH.METHODS A retrospective cohort study was conducted in tertiary care settings in individuals with confirmed diagnosis of PH at presentation.Demographic variables,clinical presentations,duration and degree of hypertension,complications,laboratory parameters including sodium,potassium levels,plasma aldosterone concentration(PAC),plasma renin activity(PRA),and aldosterone to renin ratio(ARR)and cardio-renal parameters were collected.Comparison was done between three groups:PH with no DM(Group A)or with pre-diabetes(Group B)or with T2DM(Group C).P<0.05 was statistically significant.RESULTS Among 78 individuals with confirmed PH,62%had pre-diabetes or diabetes;with 37%having DM.Mean duration of T2DM was 5.97±4.7 years.The mean levels of glycaemic parameters among the group A vs B vs C individuals were fasting plasma glucose(mg/dL):87.9±6.5,105.4±9.02,130.6±21.1;post prandial plasma glucose(mg/dL):122.7±9.8,154.9±14,196.7±38.0;glycated haemoglobin(%)(5.3±0.2,5.9±0.2,7.5±0.6,P<0.05),respectively.There was no significant difference in the biochemical parameters(PAC,PRA,ARR,sodium,potassium levels),presentation and complications between the groups.Cardio renal parameters or degree and duration of hypertension were comparable between the groups.CONCLUSION Significant prevalence of T2DM and prediabetes in PH at diagnosis does not impact its presentation or complications.Early screening for undetected PH in T2DM and prediabetes subjects with hypertension may prevent complications.
基金supported by a grant from the Science and Technology Project of Guangdong Province(No.2016A020215136)。
文摘Background:Since the diagnostic value of aldosterone to renin ratio(ARR)calculated by plasma renin concentration(PRC)or plasma renin activity(PRA)is still inconclusive,we conducted a meta-analysis by systematically reviewing relevant literature to explore the difference in the diagnostic efficacy of ARR calculated by PRC or PRA,so as to provide guidance for clinical diagnosis.Methods:We searched PubMed,Embase,and Cochrane Library from the establishment of the database to March 2021.We included studies that report the true positive,false positive,true negative,and false negative values for the diagnosis of primary aldosteronism,and we excluded duplicate publications,research without full text,incomplete information,or inability to conduct data extraction,animal experiments,reviews,and systematic reviews.STATA 15.1 was used to analyze the data.Results:The pooled results showed that ARR(plasma aldosterone concentration[PAC]/PRC)had a sensitivity of 0.82(95%confidence interval[CI]:0.78-0.86),a specificity of 0.94(95%CI:0.92-0.95),a positive-likelihood ratio(LR)of 12.77(95%CI:7.04-23.73),a negative LR of 0.11(95%CI:0.07-0.17),and symmetric area under the curve(SAUC)of 0.982,respectively.Furthermore,the diagnostic odds ratio(DOR)of ARR(PAC/PRC)was 180.21.Additionally,the pooled results showed that ARR(PAC/PRA)had a sensitivity of 0.91(95%CI:0.86-0.95),a specificity of 0.91(95%CI:0.90-0.93),a positive LR of 7.30(95%CI:2.99-17.99),a negative LR of 0.10(95%CI:0.04-0.26),and SAUC of 0.976,respectively.The DOR of ARR(PAC/PRA)was 155.52.Additionally,we conducted a subgroup analysis for the different thresholds(<35 or≥35)of PAC/PRC.The results showed that the DOR of the cut-off≥35 groups was higher than the cut-off<35 groups(DOR=340.15,95%CI:38.32-3019.66;DOR=116.40,95%CI=23.28-581.92).Conclusions:The research results suggest that the determination of ARR(PAC/PRC)and ARR(PAC/PRA)was all effective screening tools for PA.The diagnostic accuracy and diagnostic value of ARR(PAC/PRC)are higher than ARR(PAC/PRA).In addition,within a certain range,the higher the threshold,the better the diagnostic value.
文摘背景醛固酮过多是导致心肌肥厚、心力衰竭和肾功能受损的重要危险因素,导致心脏、肾脏等高血压靶器官损害更为严重。除原醛症外,临床发现部分原发性高血压患者的血浆肾素活性及血醛固酮水平升高,但目前关于原发性高血压患者血压水平与血浆肾素活性、醛固酮水平的相关性研究偏少,研究结论也不一致。目的分析原发性高血压患者血压水平与肾素-醛固酮系统活性的相关性,探讨伴高醛固酮血症的原发性高血压患者可能的病理生理机制,为此类患者的早期治疗、延缓高血压靶器官损害提供理论依据。方法检索Pub Med、EMBase、中国知网、维普网和万方数据知识服务平台,检索时限为建库至2020年1月。2名研究者根据文献纳入和排除标准独立筛选文献、提取资料并使用纽卡斯尔-渥太华质量评估量表(NOS)进行质量评价。采用Rev Man 5.2软件进行Meta分析。结果以中国高血压人群为研究对象,共纳入16篇文献、原发性高血压患者1885例、健康对照者1438例。NOS偏倚风险评价结果显示16篇文献评分均在5分以上。Meta分析结果显示:试验组的血浆肾素活性[MD=0.40,95%CI(0.04,0.76)]、血浆醛固酮水平[MD=60.03,95%CI(22.28,97.79)]高于对照组(P<0.05)。但试验组的卧位肾素活性[MD=-1.27,95%CI(-1.37,-1.16)]和立位肾素活性[MD=-1.67,95%CI(-1.88,-1.46)]均低于对照组(P<0.05)。试验组卧位醛固酮水平[MD=0.07,95%CI(0.06,0.09)]、立位醛固酮水平[MD=0.22,95%CI(0.05,0.39)]高于对照组(P<0.05)。结论(1)原发性高血压患者的血浆肾素活性、醛固酮水平与血压正常者相比是有差异的。无论是卧位采血还是立位采血,原发性高血压患者的血浆肾素水平是低于血压正常者的,而醛固酮水平是高于血压正常者的。(2)在部分原发性高血压患者中,肾素活性与醛固酮水平变化方向不一致,提示原发性高血压患者的高醛固酮血症系非肾素依赖性的不适当醛固酮水平增高。在降压药物的选择中,应包含盐皮质激素受体拮抗剂。
