Decoding Hypertension Through Primary Aldosteronism

Mitchell, Braxton D.; Whitlatch, Hilary B

doi:10.1161/circulationaha.123.064028

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…Хоча підвищення рівня альдостерону при цьому і не залежить від активації ренін-ангіотензинової системи (РАС), тим не менш, практично завжди формується норморенінова гіпокаліємічна артеріальна гіпертензія (АГ) [1]. Вважається, що під маскою гіпертонічної хвороби у 10 % пацієнтів відбувається перебіг вторинної, обумовленої гіперальдостеронізмом АГ, яка є практично єдиним постійним синдромом [2]. Підвищення артеріального тиску (АТ) зумовлене затримкою натрію, збільшенням об'єму рідини та підвищенням системного судинного периферичного опору.…”

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The problem of timely diagnosis of primary hyperaldosteronism. Clinical case

Zhdan,

Volchenko,

Babanina

et al. 2023

Mìžnarodnij endokrinologìčnij žurnal

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A clinical case is presented of delayed diagnosis of primary hyperaldosteronism (PHA) due to aldosterone-producing adenoma. Suspicion of PHA arises in case of persistent combination of hypertension with hypokalemia of various severity, a specific neuromuscular syndrome, as well as a high risk of cardiomyopathy, heart failure, and deterioration of kidney function, which are not typical for banal hypertension. Unsatisfactory blood pressure control with a standard combination of pharmacotherapy, an unexpected positive effect of mineralocorticoid receptor antagonists, high blood pressure in young people, as well as a family history of early high blood pressure or stroke at a young age, paroxysmal course of hypertension itself increases the risk of PHA. For a long time, a disease in our patient was considered a banal hypertension, although the diagnostic hypothesis of PHA should appear immediately after severe neuromuscular syndrome, rapid progression of cardiomyopathy and clinically significant heart failure began to dominate in the clinical picture. A 44-year-old female patient came to the attention of rheumatologists with suspicion of inflammatory myopathy due to frequent episodes of muscle weakness whose origin remained unclear. Key complaints of pronounced paroxysmal generalized muscle weakness, especially in the limbs, numbness and paresthesias in the extremities, calf muscle cramps against the background of hypertension were regarded as a neuromuscular syndrome specific to PHA. The PHA hypothesis was supported by the presence of cardiomyopathy, heart failure, clinically significant hypokalemia, and elevated aldosterone level. Computed tomography of the retroperitoneal space confirmed the presence of adrenal adenoma. Unfortunately, with a delay, after 13 years of hypertension, the diagnosis of PHA against the background of aldosterone-producing adenoma was confirmed. Consultation with a surgeon endocrinologist was suggested, as well as administration of eplerenone 50 mg daily in combination with lercanidipine 20 mg daily. Already after 6 weeks of pharmacotherapy, a positive therapeutic effect was obtained regarding the control of hypertension, heart failure, and the severity of neuromuscular syndrome. The differential diagnosis of secondary endocrine hypertension can be successful only with the possession of skills for early clinical detection of endocrine pathology, even in subclinical disease presentation. The diagnosis of PHA makes it possible to offer a patient radical surgical treatment, as well as to choose optimal approaches to pharmacotherapy.

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Section: вступunclassified

The problem of timely diagnosis of primary hyperaldosteronism. Clinical case

Zhdan,

Volchenko,

Babanina

et al. 2023

Mìžnarodnij endokrinologìčnij žurnal

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Primary Aldosteronism and Risk of Cardiovascular Outcomes: Genome‐Wide Association and Mendelian Randomization Study

Inoue,

Naito,

Fuji

et al. 2024

JAHA

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Background Observational studies have reported associations between primary aldosteronism (PA) and cardiovascular outcomes, including coronary artery diseases (CAD), congestive heart failure (CHF), and stroke. However, establishing causality remains a challenge due to the lack of randomized controlled trial data on this topic. We thus aimed to investigate the causal relationship between PA and the risk of developing CAD, CHF, and stroke. Methods and Results Cross‐ancestry meta‐analysis of genome‐wide association studies combining East Asian and European ancestry (1560 PA cases and 742 139 controls) was conducted to identify single‐nucleotide variants that are associated with PA. Then, using the identified genetic variants as instrumental variables, we conducted the 2‐sample Mendelian randomization analysis to investigate the causal relationship between PA and incident CAD, CHF, and stroke among both East Asian and European ancestry. Summary association results were extracted from large genome‐wide association studies consortia. Our cross‐ancestry meta‐analysis of East Asian and European populations identified 7 genetic loci significantly associated with the risk of PA, for which the genes nearest to the lead variants were CASZ1 , WNT2B , HOTTIP , LSP1 , TBX3 , RXFP2 , and NDP . Among the East Asian population, the pooled odds ratio estimates using these 7 genetic instruments of PA were 1.07 (95% CI, 1.03–1.11) for CAD, 1.10 (95% CI, 1.01–1.20) for CHF, and 1.13 (95% CI, 1.09–1.18) for stroke. The results were consistent among the European population. Conclusions Our 2‐sample Mendelian randomization study revealed that PA had increased risks of CAD, CHF, and stroke. These findings highlight that early and active screening of PA is critical to prevent future cardiovascular events.

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Decoding Hypertension Through Primary Aldosteronism

Cited by 2 publications

References 15 publications

The problem of timely diagnosis of primary hyperaldosteronism. Clinical case

The problem of timely diagnosis of primary hyperaldosteronism. Clinical case

Primary Aldosteronism and Risk of Cardiovascular Outcomes: Genome‐Wide Association and Mendelian Randomization Study

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