Suppressed Renin Status is a Risk Factor for Cardiocerebrovascular Events in Bilateral Primary Aldosteronism Treated with Mineralocorticoid Receptor Antagonists.

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Endocrine Practice Pub Date : 2024-09-09 DOI:10.1016/j.eprac.2024.09.002

Yiran Jiang,Lihua Zhou,Cui Zhang,Tingwei Su,Lei Jiang,Weiwei Zhou,Xu Zhong,Luming Wu,Weiqing Wang

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Abstract

BACKGROUND Mineralocorticoid receptor antagonists (MRAs) are the recommended medical therapy for bilateral primary aldosteronism (BPA). Compared with essential hypertension (EH), patients with BPA have higher cardiocerebrovascular disease (CCVD). There is no consensus on the criteria to assess the effectiveness of medical therapy for BPA. OBJECTIVE To investigate the incidence and the risk factors for CCVD after medical therapy of BPA. METHODS We conducted a retrospective cohort study including 240 BPA patients treated with MRA. The post-treatment plasma renin activity (PRA) was defined as unsuppressed (PRA≥1ng/ml/h) otherwise, it was defined as suppressed. We analyzed the association of post-treatment PRA status with CCVD outcomes. RESULTS 7.1% (17/240) of patients with BPA developed CCVD at a median follow-up of 5.0 (2.96,7.66) years. 57.1% of patients had PRA ≥ 1ng/ml/h after treatment. Patients with PRA <1ng/ml/h have a higher incidence of CCVD (12.6% vs. 2.9%, P < 0.05) and they are at greater risk than those with PRA ≥1ng/ml/h (HR=4.50, 95% CI: 1.47-13.83, P<0.05; adjusted HR=3.98, 95% CI: 1.22-13.02, P<0.05). CONCLUSION Patients with BPA treated with pharmacological have a high incidence of CCVD. PRA may be an indicator that mineralocorticoids are being adequately antagonized.

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肾素状态受抑制是使用矿物质皮质激素受体拮抗剂治疗的双侧原发性醛固酮增多症患者发生心脑血管事件的一个风险因素。

背景矿物皮质激素受体拮抗剂（MRA）是治疗双侧原发性醛固酮增多症（BPA）的推荐药物。与原发性高血压（EH）相比，双侧原发性醛固酮增多症患者的心脑血管疾病（CCVD）发病率更高。我们进行了一项回顾性队列研究，纳入了 240 名接受 MRA 治疗的 BPA 患者。治疗后血浆肾素活性（PRA）定义为未抑制（PRA≥1ng/ml/h），否则定义为抑制。结果 7.1%（17/240）的 BPA 患者在中位随访 5.0（2.96,7.66）年时发生了心血管疾病。57.1%的患者在治疗后PRA≥1ng/ml/h。与PRA≥1ng/ml/h的患者相比，PRA＜1ng/ml/h的患者发生心血管疾病的风险更高（12.6% vs. 2.9%，P＜0.05）（HR=4.50，95% CI：1.47-13.83，P＜0.05；调整后HR=3.98，95% CI：1.22-13.02，P＜0.05）。PRA可能是矿物质皮质激素被充分拮抗的一个指标。

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来源期刊

Endocrine Practice ENDOCRINOLOGY & METABOLISM-

CiteScore

7.60

自引率

2.40%

发文量

546

审稿时长

41 days

期刊介绍： Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.