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Первичный гиперальдостеронизм: показания для скрининга
Первичный гиперальдостеронизм: показания для скрининга
Чихладзе Н.М. Первичный гиперальдостеронизм: показания для скрининга. Терапевтический архив. 2022;94(1):107–113. DOI: 10.26442/00403660.2022.01.201324
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Аннотация
В обзоре обсуждается современное состояние проблемы скринингового обследования пациентов с целью раннего выявления первичного гиперальдостеронизма (ПГА) как потенциальной причины артериальной гипертонии (АГ). Рассмотрены особенности проведения скрининга, методические ошибки, затрудняющие интерпретацию результатов исследования. Проанализированы критерии скрининга, на основании которых можно оценить вероятность диагностики ПГА и судить о его распространенности в различных популяциях больных АГ – категориях высокого риска развития ПГА. Обращено внимание на низкий уровень скрининга больных АГ с целью выявления ПГА, на необходимость более широкого ознакомления врачей с методами скрининга и диагностики ПГА как причины неконтролируемого течения АГ. Подчеркивается важность своевременной диагностики ПГА и его целенаправленного лечения для снижения риска сердечно-сосудистых осложнений, связанных с гиперсекрецией альдостерона.
Ключевые слова: первичный гиперальдостеронизм, скрининг, артериальная гипертония
Keywords: primary hyperaldosteronism, screening, arteral hypertension
Ключевые слова: первичный гиперальдостеронизм, скрининг, артериальная гипертония
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Keywords: primary hyperaldosteronism, screening, arteral hypertension
Полный текст
Список литературы
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22. Rossi GP, Bernini G, Caliumi C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11):2293-300.
DOI:10.1016/j.jacc.2006.07.059
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DOI:10.1016/S0140-6736(08)60834-X
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27. Kaplan NM. Current diagnosis and treatment of primary aldosteronism. Expert Rev Cardiovasc Ther. 2010;8(11):1527-30. DOI:10.1586/erc.10.135
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29. Sang X, Jiang Y, Wang W, et al. Prevalence of and risk factors for primary aldosteronismamong patients with resistant hypertension in China. J Hypertens. 2013;31(7):1465-72. DOI:10.1097/HJH.0b013e328360ddf6
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39. Mulatero P, Monticone S, Burrello J, et al. Guidelines for primary aldosteronism: uptake by primary care physicians in Europe. J Hypertens. 2016;34(11):2253-7. DOI:10.1097/HJH.0000000000001088
2. Conn JW, Knopf RF, Nesbit RM. Clinical characteristics of primary aldosteronism from an analysis of 145 cases. Am J Surg. 1964;107:159-72.
DOI:10.1016/0002-9610(64)90252-1
3. Ferriss JB, Beevers DG, Brown JJ, et al. Clinical, biochemical and pathological features of low-renin ("primary") hyperaldosteronism. Am Heart J. 1978;95(3):375-88. DOI:10.1016/0002-8703(78)90370-8
4. Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007;66(5):607-18. DOI:10.1111/j.1365-2265.2007.02775.x
5. Funder JW, Carey RM, Mantero F, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-916. DOI:10.1210/jc.2015-4061
6. Rossi GP, Bisogni V, Bacca AV, et al. The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism. Int J Cardiol Hypertens. 2020;5. DOI:10.1016/j.ijchy.2020.100029
7. Mulatero P, Stowasser M, Loh KC, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab. 2004;89:1045-50. DOI:10.1210/jc.2003-031337
8. Meng Z, Zhou L, Dai Z, et al. The Quality of Clinical Practice Guidelines and Consensuses on the Management of Primary Aldosteronism:
A Critical Appraisal. Front Med (Lausanne). 2020;7:136.
DOI:10.3389/fmed.2020.00136
9. Milliez P, Girerd X, Plouin PF, et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45(8):1243-8. DOI:10.1016/j.jacc.2005.01.015
10. Monticone S, Burrello J, Tizzani D, et al. Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice. J Am Coll Cardiol. 2017;69(14):1811-20. DOI:10.1016/j.jacc.2017.01.052
11. Nishikawa T, Omura M, Satoh F, et al. Guidelines for the diagnosis and treatment of primary aldosteronism – the Japan Endocrine Society 2009. Endocr J. 2011;58(9):711-21. DOI:10.1507/endocrj.ej11-01331
12. Baguet JP, Steichen O, Mounier-Véhier C, Gosse P. SFE/SFHTA/AFCE consensus on primary aldosteronism, part 1: Epidemiology of PA, who should be screened for sporadic PA? Ann Endocrinol (Paris). 2016;77(3):187-91. DOI:10.1016/j.ando.2016.01.006
13. Amar L, Plouin PF, Steichen O. Aldosterone-producing adenoma and other surgically correctable forms of primary aldosteronism. Orphanet J Rare Dis. 2010;5:9.
DOI:10.1186/1750-1172-5-9
14. Shkhvatsabaia IK, Chihladze NM. Giperal'dosteronizm i arterial'naia gipertoniia. Moscow: Meditsina, 1984 (in Russian).
15. Mosso L, Carvajal C, González A, et al. Primary aldosteronism and hypertensive disease. Hypertension. 2003;42(2):161-5. DOI:10.1161/01.HYP.0000079505.25750.11
16. Williams JS, Williams GH, Raji A, et al. Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia. J Hum Hypertens. 2006;20(2):129-36. DOI:10.1038/sj.jhh.1001948
17. Kaplan NM. Is there an unrecognized epidemic of primary aldosteronism? Con Hypertension. 2007;50(3):454-8. DOI:10.1161/HYPERTENSIONAHA.106.086124
18. Käyser SC, Dekkers T, Groenewoud HJ, et al. Study heterogeneity and estimation of prevalence of primary aldosteronism: a systematic review and meta-regression analysis. J Clin Endocrinol Metab. 2016;101(7):2826-35. DOI:10.1210/jc.2016-1472
19. Schmiemann G, Gebhardt K, Hummers-Pradier E, et al. Prevalence of hyperaldosteronism in primary care patients with resistant hypertension. J Am Board Fam Med. 2012;25:98-103. DOI:10.3122/jabfm.2012.01.110099
20. Ruhle BC, White MG, Alsafran S, et al. Keeping primary aldosteronism in mind: Deficiencies in screening at-risk hypertensives. Surgery. 2019;165(1):221-7. DOI:10.1016/j.surg.2018.05.085
21. Olivieri O, Ciacciarelli A, Signorelli D, et al. Aldosterone to Renin ratio in a primary care setting: the Bussolengo study. J Clin Endocrinol Metab. 2004;89(9):4221-6. DOI:10.1210/jc.2003-032179
22. Rossi GP, Bernini G, Caliumi C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11):2293-300.
DOI:10.1016/j.jacc.2006.07.059
23. Calhoun DA. Is there an unrecognized epidemic of primary aldosteronism? Pro. Hypertension. 2007;50(3):447-53. DOI:10.1161/HYPERTENSIONAHA.106.086116
24. Douma S, Petidis K, Doumas M, et al. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study [published correction appears in Lancet. 2008;372(9655):2022]. Lancet. 2008;371(9628):1921-6.
DOI:10.1016/S0140-6736(08)60834-X
25. Egidi G, Schmiemann G, Gebhardt K. Is aldosteronism really a relatively common cause of hypertension? CMAJ. 2018;190(13):E403. DOI:10.1503/cmaj.68999
26. Käyser SC, Deinum J, de Grauw WJ, et al. Prevalence of primary aldosteronism in primary care: a cross-sectional study. Br J Gen Pract. 2018;68(667):e114-22. DOI:10.3399/bjgp18X694589
27. Kaplan NM. Current diagnosis and treatment of primary aldosteronism. Expert Rev Cardiovasc Ther. 2010;8(11):1527-30. DOI:10.1586/erc.10.135
28. Wu VC, Hu YH, Er LK, et al. Case detection and diagnosis of primary aldosteronism – The consensus of Taiwan Society of Aldosteronism. J Formos Med Assoc. 2017;116(12):993-1005. DOI:10.1016/j.jfma.2017.06.004
29. Sang X, Jiang Y, Wang W, et al. Prevalence of and risk factors for primary aldosteronismamong patients with resistant hypertension in China. J Hypertens. 2013;31(7):1465-72. DOI:10.1097/HJH.0b013e328360ddf6
30. Ратнер Н.А. Артериальные гипертонии. М.: Медицина, 1974 [Ratner NA. Arterial'nye gipertonii. Moscow: Meditsina, 1974 (in Russian)].
31. Kim SH, Ahn JH, Hong HC, et al. Changes in the clinical manifestations of primary aldosteronism. Korean J Intern Med. 2014;29(2):217-25. DOI:10.3904/kjim.2014.29.2.217
32. Lee JM, Kim MK, Ko SH, et al. Clinical guidelines for the management of adrenal incidentaloma. Endocrinol Metab (Seoul). 2017;32(2):200-18.
DOI:10.3803/EnM.2017.32.2.200
33. Beltsevich DG, Melnichenko GA, Kuznetsov NS, et al. Russian Association of Endocrinologists clinical practice guideline for adrenal incidentalomas differential diagnosis. Endocrine Surgery. 2016;10(4):31-42 (in Russian). DOI:10.14341/serg2016431-42
34. Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175(2):G1-34. DOI:10.1530/EJE-16-0467
35. Stowasser M, Bachmann AW, Huggard PR, et al. Severity of hypertension in familial hyperaldosteronism type I: relationship to gender and degree of biochemical disturbance. J Clin Endocrinol Metab. 2000;85(6):2160-6. DOI:10.1210/jcem.85.6.6651
36. Chikladze NM, Favorova OO, Chazova IE. Family hyperaldosteronism type I: a clinical case and review of literature. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(9):115-22 (in Russian). DOI:10.26442/terarkh2018909115-122
37. Gonzaga CC, Gaddam KK, Ahmed MI, et al. Severity of obstructive sleep apnea is related to aldosterone status in subjects with resistant hypertension. J Clin Sleep Med. 2010;6(4):363-8.
38. Umpierrez GE, Cantey P, Smiley D, et al. Primary aldosteronism in diabetic subjects with resistant hypertension. Diabetes Care. 2007;30(7):1699-703. DOI:10.2337/dc07-0031
39. Mulatero P, Monticone S, Burrello J, et al. Guidelines for primary aldosteronism: uptake by primary care physicians in Europe. J Hypertens. 2016;34(11):2253-7. DOI:10.1097/HJH.0000000000001088
2. Conn JW, Knopf RF, Nesbit RM. Clinical characteristics of primary aldosteronism from an analysis of 145 cases. Am J Surg. 1964;107:159-72.
DOI:10.1016/0002-9610(64)90252-1
3. Ferriss JB, Beevers DG, Brown JJ, et al. Clinical, biochemical and pathological features of low-renin ("primary") hyperaldosteronism. Am Heart J. 1978;95(3):375-88. DOI:10.1016/0002-8703(78)90370-8
4. Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007;66(5):607-18. DOI:10.1111/j.1365-2265.2007.02775.x
5. Funder JW, Carey RM, Mantero F, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-916. DOI:10.1210/jc.2015-4061
6. Rossi GP, Bisogni V, Bacca AV, et al. The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism. Int J Cardiol Hypertens. 2020;5. DOI:10.1016/j.ijchy.2020.100029
7. Mulatero P, Stowasser M, Loh KC, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab. 2004;89:1045-50. DOI:10.1210/jc.2003-031337
8. Meng Z, Zhou L, Dai Z, et al. The Quality of Clinical Practice Guidelines and Consensuses on the Management of Primary Aldosteronism:
A Critical Appraisal. Front Med (Lausanne). 2020;7:136.
DOI:10.3389/fmed.2020.00136
9. Milliez P, Girerd X, Plouin PF, et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45(8):1243-8. DOI:10.1016/j.jacc.2005.01.015
10. Monticone S, Burrello J, Tizzani D, et al. Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice. J Am Coll Cardiol. 2017;69(14):1811-20. DOI:10.1016/j.jacc.2017.01.052
11. Nishikawa T, Omura M, Satoh F, et al. Guidelines for the diagnosis and treatment of primary aldosteronism – the Japan Endocrine Society 2009. Endocr J. 2011;58(9):711-21. DOI:10.1507/endocrj.ej11-01331
12. Baguet JP, Steichen O, Mounier-Véhier C, Gosse P. SFE/SFHTA/AFCE consensus on primary aldosteronism, part 1: Epidemiology of PA, who should be screened for sporadic PA? Ann Endocrinol (Paris). 2016;77(3):187-91. DOI:10.1016/j.ando.2016.01.006
13. Amar L, Plouin PF, Steichen O. Aldosterone-producing adenoma and other surgically correctable forms of primary aldosteronism. Orphanet J Rare Dis. 2010;5:9.
DOI:10.1186/1750-1172-5-9
14. Шхвацабая И.К., Чихладзе Н.М. Гиперальдостеронизм и артериальная гипертония. М.: Медицина, 1984 [Shkhvatsabaia IK, Chihladze NM. Giperal'dosteronizm i arterial'naia gipertoniia. Moscow: Meditsina, 1984 (in Russian)].
15. Mosso L, Carvajal C, González A, et al. Primary aldosteronism and hypertensive disease. Hypertension. 2003;42(2):161-5. DOI:10.1161/01.HYP.0000079505.25750.11
16. Williams JS, Williams GH, Raji A, et al. Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia. J Hum Hypertens. 2006;20(2):129-36. DOI:10.1038/sj.jhh.1001948
17. Kaplan NM. Is there an unrecognized epidemic of primary aldosteronism? Con Hypertension. 2007;50(3):454-8. DOI:10.1161/HYPERTENSIONAHA.106.086124
18. Käyser SC, Dekkers T, Groenewoud HJ, et al. Study heterogeneity and estimation of prevalence of primary aldosteronism: a systematic review and meta-regression analysis. J Clin Endocrinol Metab. 2016;101(7):2826-35. DOI:10.1210/jc.2016-1472
19. Schmiemann G, Gebhardt K, Hummers-Pradier E, et al. Prevalence of hyperaldosteronism in primary care patients with resistant hypertension. J Am Board Fam Med. 2012;25:98-103. DOI:10.3122/jabfm.2012.01.110099
20. Ruhle BC, White MG, Alsafran S, et al. Keeping primary aldosteronism in mind: Deficiencies in screening at-risk hypertensives. Surgery. 2019;165(1):221-7. DOI:10.1016/j.surg.2018.05.085
21. Olivieri O, Ciacciarelli A, Signorelli D, et al. Aldosterone to Renin ratio in a primary care setting: the Bussolengo study. J Clin Endocrinol Metab. 2004;89(9):4221-6. DOI:10.1210/jc.2003-032179
22. Rossi GP, Bernini G, Caliumi C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11):2293-300.
DOI:10.1016/j.jacc.2006.07.059
23. Calhoun DA. Is there an unrecognized epidemic of primary aldosteronism? Pro. Hypertension. 2007;50(3):447-53. DOI:10.1161/HYPERTENSIONAHA.106.086116
24. Douma S, Petidis K, Doumas M, et al. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study [published correction appears in Lancet. 2008;372(9655):2022]. Lancet. 2008;371(9628):1921-6.
DOI:10.1016/S0140-6736(08)60834-X
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DOI:10.1016/S0140-6736(08)60834-X
25. Egidi G, Schmiemann G, Gebhardt K. Is aldosteronism really a relatively common cause of hypertension? CMAJ. 2018;190(13):E403. DOI:10.1503/cmaj.68999
26. Käyser SC, Deinum J, de Grauw WJ, et al. Prevalence of primary aldosteronism in primary care: a cross-sectional study. Br J Gen Pract. 2018;68(667):e114-22. DOI:10.3399/bjgp18X694589
27. Kaplan NM. Current diagnosis and treatment of primary aldosteronism. Expert Rev Cardiovasc Ther. 2010;8(11):1527-30. DOI:10.1586/erc.10.135
28. Wu VC, Hu YH, Er LK, et al. Case detection and diagnosis of primary aldosteronism – The consensus of Taiwan Society of Aldosteronism. J Formos Med Assoc. 2017;116(12):993-1005. DOI:10.1016/j.jfma.2017.06.004
29. Sang X, Jiang Y, Wang W, et al. Prevalence of and risk factors for primary aldosteronismamong patients with resistant hypertension in China. J Hypertens. 2013;31(7):1465-72. DOI:10.1097/HJH.0b013e328360ddf6
30. Ратнер Н.А. Артериальные гипертонии. М.: Медицина, 1974 [Ratner NA. Arterial'nye gipertonii. Moscow: Meditsina, 1974 (in Russian)].
31. Kim SH, Ahn JH, Hong HC, et al. Changes in the clinical manifestations of primary aldosteronism. Korean J Intern Med. 2014;29(2):217-25. DOI:10.3904/kjim.2014.29.2.217
32. Lee JM, Kim MK, Ko SH, et al. Clinical guidelines for the management of adrenal incidentaloma. Endocrinol Metab (Seoul). 2017;32(2):200-18.
DOI:10.3803/EnM.2017.32.2.200
33. Beltsevich DG, Melnichenko GA, Kuznetsov NS, et al. Russian Association of Endocrinologists clinical practice guideline for adrenal incidentalomas differential diagnosis. Endocrine Surgery. 2016;10(4):31-42 (in Russian). DOI:10.14341/serg2016431-42
34. Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175(2):G1-34. DOI:10.1530/EJE-16-0467
35. Stowasser M, Bachmann AW, Huggard PR, et al. Severity of hypertension in familial hyperaldosteronism type I: relationship to gender and degree of biochemical disturbance. J Clin Endocrinol Metab. 2000;85(6):2160-6. DOI:10.1210/jcem.85.6.6651
36. Chikladze NM, Favorova OO, Chazova IE. Family hyperaldosteronism type I: a clinical case and review of literature. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(9):115-22 (in Russian). DOI:10.26442/terarkh2018909115-122
37. Gonzaga CC, Gaddam KK, Ahmed MI, et al. Severity of obstructive sleep apnea is related to aldosterone status in subjects with resistant hypertension. J Clin Sleep Med. 2010;6(4):363-8.
38. Umpierrez GE, Cantey P, Smiley D, et al. Primary aldosteronism in diabetic subjects with resistant hypertension. Diabetes Care. 2007;30(7):1699-703. DOI:10.2337/dc07-0031
39. Mulatero P, Monticone S, Burrello J, et al. Guidelines for primary aldosteronism: uptake by primary care physicians in Europe. J Hypertens. 2016;34(11):2253-7. DOI:10.1097/HJH.0000000000001088
Авторы
Н.М. Чихладзе*
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
*novella.cardio@mail.ru
National Medical Research Center of Cardiology, Moscow, Russia
*novella.cardio@mail.ru
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия
*novella.cardio@mail.ru
________________________________________________
National Medical Research Center of Cardiology, Moscow, Russia
*novella.cardio@mail.ru
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