Practice Recommendations for Diagnosis and Treatment of the Most Common Forms of Secondary Hypertension

Rossi, Gian Paolo; Bisogni, Valeria; Rossitto, Giacomo; Maiolino, Giuseppe; Cesari, Maurizio; Zhu, Rui; Seccia, Teresa Maria

doi:10.1007/s40292-020-00415-9

Cited by 76 publications

(82 citation statements)

References 68 publications

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“…As noted above, recent data indicate that MRA may not need to be discontinued before testing for PA, but we believe, as noted in the recent Italian guidelines (Rossi et al, 2020a;Rossi et al, 2020b), that continuing MRA would be most useful primarily in specific patient subsets, such as patients with severe hypokalemia and/or severe/resistant hypertension, so the prudent approach would be to withdraw MRA if blood pressure and serum potassium can be reasonably controlled without the drug, but otherwise continue MRA.…”

Section: Discussionmentioning

confidence: 80%

“…A relatively "novel" approach of bypassing a confirmatory test and proceeding directly to AVS (Rossi et al, 2020a;Rossi et al, 2020b) also requires more data on the effect of various antihypertensive drug classes on the diagnosis of PA based on ARR measurements only. There are also ongoing attempts to develop prediction scores to avoid confirmatory testing and/or AVS (Rossi et al, 2020a;Burrello et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…The finding by the Rossi group that canrenone did not preclude an accurate diagnosis in patients with PA, is at variance with previous thinking and statements that MRA should be withdrawn before ARR measurement ( Funder et al, 2016 ). However, the view that MRAs can be used during the screening for PA because they did not cause false negative ARR values during the screening ( Rossi et al, 2020c ), and also when PA patients undergo subtype differentiation, as these drugs did not preclude the diagnosis of unilateral PA by AVS ( Haase et al, 2014 ; Nanba et al, 2019 ), was later upheld in two Italian guideline documents ( Rossi et al, 2020a ; Rossi et al, 2020b ), despite findings of other studies, both earlier and recent, that suggest otherwise ( Seifarth et al, 2002 ; Tezuka and Turcu, 2020 ). How to reconcile these apparently contradictory findings?…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, some authors question the utility of confirmatory testing, instead suggesting proceeding directly to PA subtype determination by AVS if the patient is a candidate for surgery to remove APA. According to the Italian authors ( Rossi et al, 2020a ; Rossi et al, 2020b ), the use of confirmatory tests remains controversial as they are based on the unproven premise that aldosterone secretion would be completely independent of renin and angiotensin II. These authors also note that studies supporting the use of confirmatory tests use did not comply with the Standards for Reporting of Diagnostic Accuracy (STARD) requirement for validation for diagnostic tests ( Bossuyt et al, 2003 ).…”

Section: Confirmatory Tests For Primary Aldosteronismmentioning

confidence: 99%

“…In the addition, the largest study that examined the captopril challenge test and fulfilled these requirements failed to show any diagnostic gain of this test over a carefully done ARR ( Maiolino et al, 2017 ). Thus, it was postulated in the recent Italian guidelines that if consistently elevated ARR values are found during properly performed screening, and a “florid” PA phenotype is present (identified by PAC >15 ng/dl and DRC ≤2 mIU/L, with or without hypokalemia), the confirmatory tests are useless and one may proceed directly to subtyping if the patient is candidate for surgery ( Rossi et al, 2020a ; Rossi et al, 2020b ). This approach is thus basically consistent with the one proposed in the 2016 Endocrine Society guidelines, i.e., to omit the confirmatory testing in patient with unambiguous PA phenotype, but the defining criteria vary between these guidelines.…”

Section: Confirmatory Tests For Primary Aldosteronismmentioning

confidence: 99%

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The Effect of Antihypertensive Medications on Testing for Primary Aldosteronism

et al. 2021

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Primary aldosteronism (PA) is a potentially curable form of secondary hypertension caused by excessive renin-independent aldosterone secretion, leading to increased target organ damage and cardiovascular morbidity and mortality. The diagnosis of PA requires measuring renin and aldosterone to calculate the aldosterone-to-renin ratio, followed by confirmatory tests to demonstrate renin-independent aldosterone secretion and/or PA subtype differentiation. Various antihypertensive drug classes interfere with the renin-angiotensin-aldosterone axis and hence evaluation for PA should ideally be performed off-drugs. This is, however, often precluded by the risks related to suboptimal control of blood pressure and serum potassium level in the evaluation period. In the present review, we summarized the evidence regarding the effect of various antihypertensive drug classes on biochemical testing for PA, and critically appraised the issue whether and which antihypertensive medications should be withdrawn or, conversely, might be continued in patients evaluated for PA. The least interfering drugs are calcium antagonists, alpha-blockers, hydralazine, and possibly moxonidine. If necessary, the testing may also be attempted during treatment with beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers but renin and aldosterone measurements must be interpreted in the context of known effects of these drugs on these parameters. Views are evolving on the feasibility of testing during treatment with mineralocorticoid receptor antagonists, as these drugs are now increasingly considered acceptable in specific patient subsets, particularly in those with severe hypokalemia and/or poor blood pressure control on alternative treatment.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Confirmatory Tests For Primary Aldosteronismmentioning

confidence: 99%

Section: Confirmatory Tests For Primary Aldosteronismmentioning

confidence: 99%

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The Effect of Antihypertensive Medications on Testing for Primary Aldosteronism

et al. 2021

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A biomarker panel of secondary hypertension is simultaneously quantified by coupling of magnetic solid‐phase extraction and liquid chromatography–tandem mass spectrometry

Gao,

Li,

Chen

et al. 2024

Rapid Comm Mass Spectrometry

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RationaleSecondary hypertension is often caused by activation of complex multi‐organ endocrine systems, while renin activity indicated by angiotensins (Angs), aldosterone (ALD) and cortisol (COR) in such systems are generally accepted as its diagnostic markers. As antibody‐based methods cannot offer comparable quantification for these biomarkers, a liquid chromatography (LC)–tandem mass spectrometry (MS/MS)‐based approach was developed to quantify them simultaneously and accurately.MethodsFive different beads for magnetic solid‐phase extraction (MSPE) were evaluated towards their enrichment efficiency for these biomarkers. An LC system with optimized elution gradient and a triple‐quadrupole MS with tuned parameters were coupled to quantitatively monitor the extracted analytes. The method performance was further examined such as linearity, precision, stability, recovery rate and matrix effect. Based on the developed method, the abundance of Ang II, ALD and COR in plasma was measured and the quantification was compared with that derived from commercial ELISA kits.ResultsAs compared with other MSPEs, Angs, ALD and COR were highly enriched by the HLB magnetic beads with satisfactory recoveries. These analytes were simultaneously quantified by LC/MS/MS and all the method parameters for quantification were well matched with the requirements of clinical testing. Comparison of the quantitative results derived from ELISA and LC/MS/MS exhibited that the two methods offered basically comparable values with Pearson r values at 0.896, 0.895 and 0.835, respectively. The stability test for plasma Angs at room temperature indicated that the abundance of Ang II was relatively stable within 3 h, whereas that of Ang I and Ang 1–7 was time‐dependently changed.ConclusionsCoupling of HLB beads and LC/MS/MS thus enables simultaneous quantification of a set of biomarkers related to secondary hypertension.

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