Search

A real-world study on the impact of antihypertensive drugs on screening tests for primary aldosteronism

Objective To evaluate the effect of antihypertensive agents on primary aldosteronism (PA) screening test in the real world clinical practice; to explore the antihypertensive regimen and the corresponding aldosterone versus renin ratio (ARR) cut-off point of hypertension patients undergoing PA screening. Methods Hypertensive patients who underwent PA screening in the Department of Endocrinology & Metabolism of West China Hospital of Sichuan University between January 2010 and December 2020 were selected. According to the PA diagnostic criteria, patients were divided into the PA group and the essential hypertension (EH) group. The antihypertensive drugs, diastolic blood pressure, systolic blood pressure, blood electrolyte, plasma renin activity, plasma aldosterone, ARR were collected before and after the washout period; aldosterone before and after captopril test, and aldosterone before and after saline infusion test were collected. The above indicators of the two groups of patients were compared and analyzed. Results A total of 488 patients were included. Among them, there were 391 cases in the PA group and 97 cases in the EH group. There were statistically significant differences in age, systolic blood pressure, diastolic blood pressure, blood sodium, blood potassium, plasma renin activity, aldosterone, and ARR between the two groups (P<0.05). There was a significant difference in diagnostic results for PA screening between pre-eluting ARR and post-eluting ARR among patients taking 1-3 antihypertensive agents; however, there was no significant difference among patients taking 4 or more antihypertensive agents (P=0.547). Among the 488 patients included, calcium channel blocker and/or angiotensin converting enzyme inhibitors / angiotensin receptor interceptor were the most used antihypertensive regimen. ARR≥23.6(ng/dL)/[ng/(mL·h)] could be used as the cut-off point of ARR screening PA before elution. Conclusions When PA screening is performed in patients with hypertension, it can be directly screened for patients taking 4 or more antihypertensive drugs. As to patients taking 1-3 antihypertensive drugs, such as calcium channel blocker and/or angiotensin converting enzyme inhibitors / angiotensin receptor interceptor, ARR≥23.6 (ng/dL)/[ng/(mL·h)] can be selected as the cut-off value.

The interpretation of antihypertensive drugs rational use guideline: RAAS inhibitors for hypertension complications

Effect of Circadian Variability of Dipper Blood Pressure Induced by Irbesartan in Patients with NonDipper Essential Hypertension on Levels of Aldosterone

摘要:目的：觀察厄貝沙坦治療非杓型高血壓患者降壓效果及其杓型血壓晝夜節律恢復情況,并觀察治療后血漿醛固酮水平的影響。方法:對杓型和非杓型兩組原發性高血壓患者分別給予150300 mg/d,觀察降壓效果及對血壓晝夜節律的影響,并監測用藥前后血漿醛固酮水平的變化。結果:所有高血壓患者應用厄貝沙坦治療前后收縮壓及舒張壓均有不同程度的下降,非杓型組夜間收縮壓及舒張壓的下降值與杓型相比有統計學差異,出現了明顯的晝夜節律,血漿醛固酮水平出現了明顯差異。結論:厄貝沙坦對非杓型高血壓患者有良好的降壓作用,并能恢復非杓型高血壓患者的晝夜節律,向杓型血壓變化。Abstract: Objective: To investigate the effect of blood pressure control and circadian variability of dipper blood pressure induced by irbesartan in patients with nondipper essential hypertension and to observe levels of aldosterone.after treatment.Methods:The patients were divided into dipper and nondipper groups. All patients were treated with irbesartan (150300 mg/d). The variability of circadian blood pressure were observed, and the levels of plasma aldosterone were monitored before and after treatment Results: After the treatment with irbesartan, the blood pressure in all patients were evidently reduced. The night blood pressure of the patient with nondipper essential hypertension had more significant improvement . The circadian variability was appeared. The levels of aldosterone had a significant difference between day and night. Conclusion:Irbesartan has significant effects for the patients with nondipper essential hypertension. It can induce a circadian variability and recover the dipper blood pressure from nondipper blood pressure.