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Hypertension in Childhood Cancer Survivors: Causes, Screening, and Management.
IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-03-14 DOI: 10.1007/s11906-025-01330-x
Natalie L Wu, Coral D Hanevold

Purpose of review: Survivors of childhood cancer and hematopoietic cell transplant are at risk for developing chronic health conditions, including hypertension. Studies have identified hypertension as an influential risk factor for late kidney dysfunction and cardiovascular disease in childhood cancer survivors. The overall risk of hypertension depends on the specific cancer treatment, from chemotherapy to surgery to radiation. In this report, we aim to review the main causes of hypertension in childhood cancer survivors, with a focus on newer therapies, as well as the current recommendations for screening and management of hypertension in this patient population.

Recent findings: Novel targeted therapies and immunotherapies are being increasingly used in pediatric cancer treatment, with unclear impact on long-term health. Screening guidelines for hypertension in the survivor population have been issued by various childhood cancer cooperative groups based on best available evidence and expert opinion. Newer studies have focused on individual risk prediction, which may help improve the diagnosis and management of hypertension, particularly in higher-risk individuals. Despite the importance of hypertension as one of the few modifiable risk factors for cardiovascular and renal health, studies have yet to define optimal blood pressure targets, screening parameters, or management strategies in childhood cancer survivors. Additionally, further studies are needed to demonstrate improvement in outcomes following interventions for hypertension specifically in this patient population.

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引用次数: 0
Hypertension, Obesity, and Target Organ Injury in Children: An Emerging Health Care Crisis. 儿童高血压、肥胖症和靶器官损伤:新出现的医疗危机。
IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-02-27 DOI: 10.1007/s11906-025-01329-4
Andrew H Tran, Aaron Walsh, Elaine M Urbina

Purpose of review: To review data regarding the association between hypertension and childhood obesity on target organ damage. We will also review data regarding the impact of intervening on hypertension and childhood obesity on target organ damage.

Recent findings: The prevalence of hypertension and obesity are rising in children despite efforts to address these risk factors. Health disparities play a role in contributing to the rise in prevalence. Hypertension and obesity promote pro-inflammatory cytokines that activate the renin-angiotensin-aldosterone system and sympathetic nervous system which result in adverse effects on blood pressure regulation and renal function. Adverse cardiac, vascular, renal, neurocognitive, and retinal changes can be seen with elevated blood pressure. Recent intervention studies are few, but adequate treatment of hypertension and obesity can result in improvement in target organ damage. Hypertension and obesity have significant impacts upon target organs. Interventions to decrease blood pressure and treat obesity are associated with reductions in left ventricular hypertrophy, improvement in measures of systolic and diastolic function, and improvement in renal outcomes. Appropriate screening and management of these conditions can lessen potential future cardiovascular impact.

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引用次数: 0
Urinary Biomarkers Of Kidney Function As Predictors Of Cardiovascular Health: A Systematic Review. 预测心血管健康的肾功能尿液生物标志物:系统回顾
IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-02-21 DOI: 10.1007/s11906-025-01328-5
A Degenaar, R Kruger, A Jacobs, C M C Mels

Purpose of review: The growing burden of cardiovascular diseases has become a significant concern in both adult and youth populations. Urinary biomarkers of kidney function could provide useful insights that may aid in the early identification of individuals at higher risk of adverse cardiovascular outcomes. This systematic review aimed to assess associations between urinary biomarkers of kidney function and different measures of cardiovascular health.

Recent findings: PubMed, Scopus, and EBSCOhost were searched for articles published between January 2018 and December 2023. Studies exploring associations between urinary kidney biomarkers (alpha-1 microglobulin (uA1M), neutrophil gelatinase-associated lipocalin (uNGAL), uromodulin (uUMOD) and CKD273 classifier) and measures of cardiovascular health (blood pressure and markers of target organ damage) were included. We identified 1186 articles, with 22 studies eligible for inclusion. Among 12 studies reporting associations between uA1M and measures of cardiovascular health, six studies indicated positive associations with office blood pressure and three studies observed associations with different markers of target organ damage. Out of the nine studies that explored the link between uUMOD and cardiovascular health parameters, four found negative associations between uUMOD and blood pressure. With regard to uNGAL, only two out of the seven studies analysed reported varying associations with blood pressure, while neither of the two studies focusing on CKD273 observed any statistically significant results. Biomarkers of kidney tubule function, represented by uA1M and uUMOD, are relevant in the setting of cardiovascular health and should be assessed for utilisation in clinical practice to identify adverse cardiovascular outcomes at an early stage allowing for timely intervention.

审查目的:心血管疾病的负担日益加重,已成为成人和青少年群体的一个重大问题。尿液肾功能生物标志物可提供有用的见解,有助于早期识别心血管不良后果风险较高的人群。本系统综述旨在评估尿液肾功能生物标志物与心血管健康不同指标之间的关联:在PubMed、Scopus和EBSCOhost上检索了2018年1月至2023年12月期间发表的文章。纳入了探讨尿液肾脏生物标志物(α-1微球蛋白(uA1M)、中性粒细胞明胶酶相关脂褐素(uNGAL)、尿调蛋白(uUMOD)和CKD273分类器)与心血管健康指标(血压和靶器官损伤标志物)之间关系的研究。我们确定了 1186 篇文章,其中 22 项研究符合纳入条件。在 12 项报告 uA1M 与心血管健康指标之间关系的研究中,有 6 项研究表明与办公室血压存在正相关关系,有 3 项研究观察到与不同的靶器官损伤标志物存在相关关系。九项研究探讨了uUMOD与心血管健康参数之间的联系,其中四项研究发现uUMOD与血压之间存在负相关。至于uNGAL,所分析的七项研究中只有两项报告了与血压的不同关联,而两项以CKD273 为重点的研究均未观察到任何具有统计学意义的结果。以 uA1M 和 uUMOD 为代表的肾小管功能生物标志物与心血管健康相关,应在临床实践中加以评估利用,以便及早发现心血管不良后果,及时进行干预。
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引用次数: 0
Factors associated with preeclampsia and the hypertensive disorders of pregnancy amongst Indigenous women of Canada, Australia, New Zealand, and the United States: A systematic review and meta-analysis.
IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-02-20 DOI: 10.1007/s11906-025-01327-6
Jacqueline Stephens, Eleonora Dal Grande, Tayla Roberts, Marianne Kerr, Celine Northcott, Tahlia Johnson, Jessie Sleep, Courtney Ryder

Purpose of the review: Preeclampsia and the Hypertensive Disorders of Pregnancy (HDP) occur more frequently amongst Indigenous women and can have short- and long-term impacts on maternal and infant health and wellbeing. To understand factors associated with increased risk for Indigenous women a systematic review and meta-analysis was conducted. The PRISMA guidelines were adhered to, and the review protocol was registered on PROSPERO (Registration CRD42023381847). EndNote, Covidence and Excel were used to screen and extract data, with studies assessed using JBI critical appraisal tools.

Recent findings: Seven studies from Canada, Australia, and the United States (none from New Zealand) were included in this review. Meta-analysis showed women classified as overweight (OR 1.32, 95% CI: 1.09-1.60), obese (OR 1.88, 95% CI: 1.57-2.25), or having high mean BMI (MD 3.02 95% CI: 1.72-4.31), high mean systolic blood pressure (MD 15.19 95% CI: 12.83-17.541), or high mean diastolic blood pressure (MD 15.26 95% CI: 13.05-17.47), pre-pregnancy diabetes (OR 3.63, 95% CI: 1.66-17.94), or high microalbuminuria (OR 2.76, 95% CI: 1.40-5.43) were more likely to be diagnosed with preeclampsia. Smoking (OR 0.77, 95% CI: 0.58-1.03), alcohol consumption (OR 1.70, 95% CI: 0.76-3.81), and gestational diabetes (OR 1.74, 95% CI: 0.90-3.37) were not associated with preeclampsia. Understanding factors associated with increased preeclampsia/HDP risk amongst Indigenous women is important to minimising adverse perinatal events and future health complications. This review demonstrates current gaps in the evidence, specifically in relation to social, economic, and environmental factors.

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引用次数: 0
Does Nocturnal Blood Pressure Matter in Retinal Small Vessels? A Systematic Review and Meta-Analysis of the Literature. 夜间血压对视网膜小血管有影响吗?文献的系统回顾与元分析。
IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-18 DOI: 10.1007/s11906-025-01326-7
Christina Antza, Smaro Palaska, Panagiota Anyfanti, Dimitris Triantis, Stavros Fyntrilakis, Yusuf ZiyaSener, Vasilios Kotsis

Purpose of the review: Τhe association between nocturnal blood pressure (BP) and alterations in the retinal microvasculature remains understudied, with few available studies to provide conflicting results. Therefore, we conducted a systematic review and meta-analysis to determine whether an association exists between retinal microvascular alterations and nocturnal BP patterns, determined by 24h ambulatory BP measurement.

Recent findings: Our search concluded to 1002 patients (6 studies). A total of 3 studies (411 patients) were enrolled in the meta-analysis. Central retinal arteriolar equivalent found to be not different between patients with and without dipping status (mean differences [MD]: -0.01; 95% CI: -0.23 to 0.20; I²=0%; P < 0.610). Regarding central retinal venular equivalent, dippers showed significantly lower values compared to non-dippers (MD: -0.25; 95% CI: -0.47 to -0.03; I²=0%; P < 0.024). For the comparison between nighttime and daytime BP regarding the damage in small retinal vessels, we identified only 5 studies. Due to different evaluated outcomes as well as due to the heterogeneity of outcomes and different grouping of patients based on different BP cut-off values, these results couldn't be analyzed quantitatively. In summary, this is the first effort to summarize evidence on the effects of day-to-night variation of BP on the retinal small vessels. According to the findings of the present systematic review and meta-analysis, non-dipping status may be associated with retinal venular dilatation, and elevated nighttime BP with retinal arteriolar narrowing. Further studies are warranted to elucidate the impact of nocturnal BP patterns in the retinal microvasculature.

综述的目的:Τhe夜间血压(BP)与视网膜微血管改变之间的关系仍未得到充分研究,很少有研究提供相互矛盾的结果。因此,我们进行了一项系统综述和荟萃分析,以确定视网膜微血管改变与夜间血压模式之间是否存在关联,通过24小时动态血压测量来确定。最新发现:我们的研究共纳入1002例患者(6项研究)。荟萃分析共纳入3项研究(411例患者)。视网膜中央动脉当量在有和没有浸入状态的患者之间没有差异(平均差异[MD]: -0.01;95% CI: -0.23 ~ 0.20;²= 0%;P
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引用次数: 0
Approach to Endocrine Hypertension: A Case-Based Discussion. 内分泌性高血压的治疗方法:基于病例的讨论。
IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-16 DOI: 10.1007/s11906-025-01323-w
Sanja Borozan, A B M Kamrul-Hasan, Sahana Shetty, Joseph M Pappachan

Purpose of review: Hypertension remains a major chronic disease morbidity across the world, even in the twenty-first century, affecting ≈40% of the global population, adversely impacting the healthcare budgets in managing the high incidence of cardiovascular disease (CVD) complications and mortality because of elevated blood pressure (BP). However, evaluation and management of endocrine hypertension are not optimal in clinical practice. With three unique clinical case scenarios, we update the evidence base for diagnostic evaluation and management of endocrine hypertension in this review to inform appropriate day-to-day clinical practice decisions.

Recent findings: Although most individuals with high BP suffer from essential hypertension (≈85%), some patients may have a clear underlying etiology (termed secondary hypertension), and a significant proportion of these patients have endocrine hypertension (≈10%) consequent to hormone excess from dysfunction of one or more endocrine glands. Even if a relatively common disease in the general population, the correct diagnosis and appropriate treatment of endocrine hypertension is often delayed because of poor awareness among clinicians, including primary care providers and physicians in the secondary care settings. An accurate and timely diagnosis of endocrine hypertension is crucial to potentially cure or at least properly manage these patients because the consequences of delays in diagnosis can be catastrophic, with markedly higher end-organ complications such as CVD, chronic kidney disease, and even premature mortality among sufferers.

回顾目的:即使在21世纪,高血压仍然是世界范围内主要的慢性疾病发病率,影响着全球约40%的人口,对管理心血管疾病(CVD)并发症高发和血压升高(BP)导致的死亡率的医疗预算产生不利影响。然而,临床上对内分泌性高血压的评价和管理并不理想。通过三个独特的临床病例,我们在本综述中更新了内分泌高血压诊断评估和管理的证据基础,以告知适当的日常临床实践决策。最新发现:虽然大多数高血压患者患有原发性高血压(≈85%),但一些患者可能有明确的潜在病因(称为继发性高血压),并且这些患者中很大一部分患有内分泌高血压(≈10%),这是由于一个或多个内分泌腺功能障碍导致的激素过量所致。即使是普通人群中相对常见的疾病,由于临床医生(包括初级保健提供者和二级保健机构的医生)的认识不足,内分泌高血压的正确诊断和适当治疗往往被推迟。准确和及时的内分泌高血压诊断对于潜在地治愈或至少对这些患者进行适当的管理至关重要,因为诊断延误的后果可能是灾难性的,最终器官并发症(如心血管疾病、慢性肾病)明显增加,甚至患者过早死亡。
{"title":"Approach to Endocrine Hypertension: A Case-Based Discussion.","authors":"Sanja Borozan, A B M Kamrul-Hasan, Sahana Shetty, Joseph M Pappachan","doi":"10.1007/s11906-025-01323-w","DOIUrl":"10.1007/s11906-025-01323-w","url":null,"abstract":"<p><strong>Purpose of review: </strong>Hypertension remains a major chronic disease morbidity across the world, even in the twenty-first century, affecting ≈40% of the global population, adversely impacting the healthcare budgets in managing the high incidence of cardiovascular disease (CVD) complications and mortality because of elevated blood pressure (BP). However, evaluation and management of endocrine hypertension are not optimal in clinical practice. With three unique clinical case scenarios, we update the evidence base for diagnostic evaluation and management of endocrine hypertension in this review to inform appropriate day-to-day clinical practice decisions.</p><p><strong>Recent findings: </strong>Although most individuals with high BP suffer from essential hypertension (≈85%), some patients may have a clear underlying etiology (termed secondary hypertension), and a significant proportion of these patients have endocrine hypertension (≈10%) consequent to hormone excess from dysfunction of one or more endocrine glands. Even if a relatively common disease in the general population, the correct diagnosis and appropriate treatment of endocrine hypertension is often delayed because of poor awareness among clinicians, including primary care providers and physicians in the secondary care settings. An accurate and timely diagnosis of endocrine hypertension is crucial to potentially cure or at least properly manage these patients because the consequences of delays in diagnosis can be catastrophic, with markedly higher end-organ complications such as CVD, chronic kidney disease, and even premature mortality among sufferers.</p>","PeriodicalId":10963,"journal":{"name":"Current Hypertension Reports","volume":"27 1","pages":"8"},"PeriodicalIF":3.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sodium-Directed Crosstalk Between Immune Cells and Lymphatic Vessels. 免疫细胞和淋巴管之间的钠定向串扰。
IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-15 DOI: 10.1007/s11906-024-01322-3
Taseer Ahmad, Rachelle Crescenzi, Valentina Kon, Annet Kirabo, Elaine L Shelton

Purpose of review: The role of the lymphatic system in clearing extravasated fluids, lipid transport, and immune surveillance is well established, and lymphatic vasculature can provide a vital role in facilitating crosstalk among various organ systems. Lymphatic vessels rely on intrinsic and local factors to absorb and propel lymph from the interstitium back to the systemic circulation. The biological implications of local influences on lymphatic vessels are underscored by the exquisite sensitivity of these vessels to environmental stimuli. This review is intended to highlight the role of sodium within the local environment in mediating lymphatic and immune cell interactions that contribute to changes in function and disease progression.

Recent findings: We discuss evidence that accumulation of interstitial sodium modulates lymphatic growth, pumping dynamics, and permeability of renal lymphatics, which involves activation of sodium potassium chloride co-transporter (NKCC1) in lymphatic endothelial cells. These recent findings complement observations that sodium activates immune cells via the epithelial sodium channel (ENaC), leading to the formation and accumulation of lipid oxidation products, isolevuglandins (IsoLGs), in antigen presenting cells, which in turn promotes T cell activation and vasculopathy. In addition, we will underscore the physiologic relevance of altered interplay between immune cells and lymphatics in the sodium avid state that characterizes kidney diseases and consider how sodium accumulation in the interstitial compartment of the kidney modulates the lymphatic network and the interactions between renal lymphatics and activated immune cells. Finally, this article calls attention to persisting knowledge gaps and stresses the need for additional studies to identify salt-sensing mechanisms, including sodium-activated immune cells and lymphatic endothelial cell interactions, for targeted therapeutic interventions in the setting of renal disease.

综述目的:淋巴系统在清除外渗液、脂质转运和免疫监测方面的作用已经得到证实,淋巴血管系统在促进各器官系统之间的相互作用方面发挥着重要作用。淋巴管依靠内在和局部因素吸收和推动淋巴从间质回到体循环。局部影响对淋巴管的生物学意义被这些血管对环境刺激的敏感性所强调。本综述旨在强调钠在局部环境中介导淋巴和免疫细胞相互作用的作用,这些相互作用有助于功能改变和疾病进展。最近的发现:我们讨论了间质钠的积累调节淋巴生长、泵动动力学和肾淋巴通透性的证据,这涉及淋巴内皮细胞中氯化钠钾共转运体(NKCC1)的激活。这些最近的发现补充了钠通过上皮钠通道(ENaC)激活免疫细胞的观察结果,导致抗原呈递细胞中脂质氧化产物、异evolugandins (IsoLGs)的形成和积累,从而促进T细胞活化和血管病变。此外,我们将强调肾脏疾病中钠缺乏状态下免疫细胞和淋巴管相互作用改变的生理学相关性,并考虑肾间质室中钠的积累如何调节淋巴网络以及肾淋巴管和活化免疫细胞之间的相互作用。最后,本文呼吁关注持续存在的知识空白,并强调需要进一步研究以确定盐敏感机制,包括钠活化免疫细胞和淋巴内皮细胞相互作用,以便在肾脏疾病的背景下进行靶向治疗干预。
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引用次数: 0
Guidance for Prescribing Oral Antihypertensive Medications in the Emergency Department. 急诊科口服降压药处方指南
IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-15 DOI: 10.1007/s11906-025-01324-9
Pia-Allison Roa, John Hennessy, Nora Akcasu, Phillip D Levy, Michael J Twiner

Purpose of review: To review the most current recommendations regarding assessment and treatment of asymptomatic hypertension treatment in the emergency department (ED) and to provide guidance for prescribing oral antihypertensive therapy for ED providers.

Recent findings: There are varying management strategies for the treatment of asymptomatic hypertension in the ED likely due to a lack of direct guidelines for treatment. There is an increasing body of evidence for the safety of initiating therapy to treat chronic asymptomatic hypertension in the ED. Initiation and optimization of oral antihypertensive therapy in indicated patients can be done by ED providers to enhance and expediate transition of care for patients and can ultimately aid in prevention of cardiovascular disease (CVD). This review provides guidance of when oral antihypertensive therapy can be initiated, medication options depending on the patient's blood pressure and other concurrent medications (if applicable), as well as other factors that may influence choice of therapy are described. Oral antihypertensive therapies can be initiated and optimized in the ED for patients with asymptomatic chronic hypertension.

综述的目的:回顾最新的关于在急诊科(ED)评估和治疗无症状高血压的建议,并为急诊科医生处方口服降压药提供指导。最近的研究发现:由于缺乏直接的治疗指南,治疗ED无症状高血压的管理策略多种多样。越来越多的证据表明,在急诊科开始治疗慢性无症状高血压的安全性。急诊科医生可以对适应症患者开始和优化口服降压治疗,以加强和加快患者的护理过渡,并最终有助于预防心血管疾病(CVD)。本综述提供了何时开始口服降压治疗的指导,根据患者的血压和其他并发药物(如果适用)的药物选择,以及其他可能影响治疗选择的因素。对于无症状慢性高血压患者,可以在急诊科开始并优化口服降压治疗。
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引用次数: 0
Small Interfering RNA Therapy for the Management and Prevention of Hypertension. 小干扰RNA治疗高血压的管理和预防。
IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Pub Date : 2025-01-14 DOI: 10.1007/s11906-025-01325-8
Liwei Ren, A H Jan Danser

Purpose of review: To review currently existing knowledge on a new type of antihypertensive treatment, small interfering RNA (siRNA) targeting hepatic angiotensinogen.

Recent findings: Targeting angiotensinogen synthesis in the liver with siRNA allows reaching a suppression of renin-angiotensin system (RAS) activity for up to 6 months after 1 injection. This might revolutionize antihypertensive treatment, as it could overcome non-adherence, the major reason for inadequate blood pressure control. Animal data support that its effects on blood pressure and end-organ damage are fully comparable to those of classical RAS blockers, and phase I and II clinical trials confirm its antihypertensive effectiveness and long-term action. Although its side effect profile is placebo-like, its long-term effects also pose a threat in patients who require immediate restoration of RAS activity, like in shock. Here tools are being developed, called REVERSIR, that allow immediate annihilation of the siRNA effect in the liver. One subcutaneous injection of angiotensinogen siRNA lowers blood pressure for 6 months without severe side effects. The decrease in angiotensinogen and blood pressure can be reversed with a drug called REVERSIR if needed.

综述目的:回顾目前有关一种新型降压疗法--靶向肝脏血管紧张素原的小分子干扰 RNA(siRNA)的知识:最近的发现:用 siRNA 靶向肝脏血管紧张素原的合成,可在注射 1 次后抑制肾素-血管紧张素系统(RAS)的活性长达 6 个月。这可能会彻底改变降压治疗,因为它能克服不坚持治疗这一血压控制不佳的主要原因。动物实验数据证明,它对血压和内脏器官损伤的影响完全可与传统的 RAS 阻断剂相媲美,而 I 期和 II 期临床试验也证实了它的降压效果和长期作用。虽然它的副作用类似安慰剂,但其长期作用也对需要立即恢复 RAS 活性的患者(如休克患者)构成威胁。目前正在开发一种名为 REVERSIR 的工具,可以立即消除 siRNA 在肝脏中的作用。只需皮下注射一次血管紧张素原 siRNA,就能在 6 个月内降低血压,且无严重副作用。如果需要,还可以使用一种名为 REVERSIR 的药物来逆转血管紧张素原和血压的下降。
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引用次数: 0
Diagnosis of Primary Aldosteronism without Discontinuation of Interfering Antihypertensive Medications. 诊断原发性醛固酮增多症,无需停用干扰性降压药物。
IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Pub Date : 2024-12-16 DOI: 10.1007/s11906-024-01319-y
Zhichao Dong, Xiaoxiao Song, Minyue Jia, Jinliang Chen, Yuhao Zhang, Hanxiao Yu, Yongli Ji, Lizhen Shan, Tianyue Zhang, Chao Zheng, Jiaming Wen, Xiaohong Xu

Purpose of review: One of the challenges in the diagnosis and management of primary aldosteronism (PA), the most common type of secondary hypertension with curative potential, is the modification of antihypertensive medications. We seek to explore whether these medications can be continued during the diagnostic process of PA to minimize the duration and risks associated with medication adjustments.

Recent findings: We searched PubMed for eligible original literature between 1990 and 2024 using the following keywords: (screening) AND (primary aldosteronism); (confirmatory) AND (primary aldosteronism); (adrenal vein sampling) AND primary aldosteronism). Some recent studies support the feasibility of PA-related tests and even adrenal vein sampling (AVS) without the need to discontinue antihypertensive medications in certain cases. In this review, we propose a management approach that considers the specific effects of antihypertensive medications on the RAAS axis and the patient's disease phenotype. Based on this, we suggest a strategy that enables the diagnosis of PA in certain patients without discontinuing their antihypertensive medications.

原发性醛固酮增多症(primary醛固酮增多症,PA)是最常见的继发性高血压,具有治疗潜力,其诊断和治疗面临的挑战之一是调整降压药物。我们试图探讨在PA的诊断过程中是否可以继续使用这些药物,以尽量减少与药物调整相关的持续时间和风险。近期发现:我们在PubMed检索1990年至2024年间符合条件的原始文献,使用以下关键词:(筛选)和(原发性醛固酮增多症);(证实性)和(原发性醛固酮增多症);(肾上腺静脉取样)和原发性醛固酮增多症)。最近的一些研究支持pa相关试验的可行性,甚至在某些情况下无需停止抗高血压药物的肾上腺静脉采样(AVS)。在这篇综述中,我们提出了一种考虑抗高血压药物对RAAS轴和患者疾病表型的特定影响的管理方法。基于此,我们建议一种策略,使某些患者在不停用降压药的情况下诊断出PA。
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引用次数: 0
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