{"title":"高醛固酮增多症术后持续性高血压的预测危险因素评价。","authors":"Amal Ourdi, Youssra Laalaoua, Imane Assarrar, Bouichrat Nisrine, Siham Rouf, Hanane Latrech","doi":"10.5812/ijem-156728","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Primary hyperaldosteronism (PHA) is a common cause of secondary arterial hypertension (AH), characterized by autonomous aldosterone secretion. It is frequently underdiagnosed and may persist even after surgical intervention.</p><p><strong>Objectives: </strong>The present study aimed to identify preoperative factors that could predict whether hypertension would persist or normalize following surgery and to outline relevant diagnostic characteristics.</p><p><strong>Methods: </strong>We conducted a descriptive, analytic, retrospective cohort study at a single center. The study included patients with PHA who were followed up at the Department of Endocrinology, Diabetology, and Nutrition in a hospital affiliated with Mohamed the First University of Oujda (CERBO), admitted between December 2014 and August 2023. Data were retrospectively collected from patient records over a 9-year period, involving 27 patients with PHA confirmed by an elevated aldosterone-to-renin ratio (ARR). Persistent disease was defined by persistent hypokalemia and hypertension (blood pressure > 140/90 mm Hg) after six months. Patients were divided into two groups: Those with complete resolution of hypertension (group A) and those with persistent hypertension (group B). Data were analyzed using SPSS version 21.</p><p><strong>Results: </strong>The mean age of patients was 48.47 ± 10.87 years, with a female predominance (66.7%). The etiological assessment identified Conn's adenoma in 70.4% (n = 19) of cases and bilateral adrenal hyperplasia in 29.6% (n = 8). Surgery was performed in 51.9% (n = 14) of cases, with 50% (n = 7) maintaining persistent hypertension post-surgery, while 28.6% (n = 4) showed a reduction in antihypertensive medications. Two predictive factors for persistent hypertension were identified: Age > 50 years and hypertension duration > 5 years. Predictive factors for normalization of hypertension post-surgery included systolic blood pressure (SBP) < 140 mm Hg, diastolic blood pressure (DBP) < 90 mm Hg, glomerular filtration rate (GFR) > 90 mL/min/1.75 m<sup>2</sup>, and a low incidence of diabetes and dyslipidemia.</p><p><strong>Conclusions: </strong>This study demonstrates that PHA can lead to resistant hypertension, highlighting the necessity for further research in this area.</p>","PeriodicalId":13969,"journal":{"name":"International Journal of Endocrinology and Metabolism","volume":"23 2","pages":"e156728"},"PeriodicalIF":1.8000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301664/pdf/","citationCount":"0","resultStr":"{\"title\":\"Evaluation of Predictive Risk Factors of Persistent Hypertension in Hyperaldosteronism After Surgery.\",\"authors\":\"Amal Ourdi, Youssra Laalaoua, Imane Assarrar, Bouichrat Nisrine, Siham Rouf, Hanane Latrech\",\"doi\":\"10.5812/ijem-156728\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Primary hyperaldosteronism (PHA) is a common cause of secondary arterial hypertension (AH), characterized by autonomous aldosterone secretion. It is frequently underdiagnosed and may persist even after surgical intervention.</p><p><strong>Objectives: </strong>The present study aimed to identify preoperative factors that could predict whether hypertension would persist or normalize following surgery and to outline relevant diagnostic characteristics.</p><p><strong>Methods: </strong>We conducted a descriptive, analytic, retrospective cohort study at a single center. The study included patients with PHA who were followed up at the Department of Endocrinology, Diabetology, and Nutrition in a hospital affiliated with Mohamed the First University of Oujda (CERBO), admitted between December 2014 and August 2023. Data were retrospectively collected from patient records over a 9-year period, involving 27 patients with PHA confirmed by an elevated aldosterone-to-renin ratio (ARR). Persistent disease was defined by persistent hypokalemia and hypertension (blood pressure > 140/90 mm Hg) after six months. Patients were divided into two groups: Those with complete resolution of hypertension (group A) and those with persistent hypertension (group B). Data were analyzed using SPSS version 21.</p><p><strong>Results: </strong>The mean age of patients was 48.47 ± 10.87 years, with a female predominance (66.7%). The etiological assessment identified Conn's adenoma in 70.4% (n = 19) of cases and bilateral adrenal hyperplasia in 29.6% (n = 8). Surgery was performed in 51.9% (n = 14) of cases, with 50% (n = 7) maintaining persistent hypertension post-surgery, while 28.6% (n = 4) showed a reduction in antihypertensive medications. Two predictive factors for persistent hypertension were identified: Age > 50 years and hypertension duration > 5 years. Predictive factors for normalization of hypertension post-surgery included systolic blood pressure (SBP) < 140 mm Hg, diastolic blood pressure (DBP) < 90 mm Hg, glomerular filtration rate (GFR) > 90 mL/min/1.75 m<sup>2</sup>, and a low incidence of diabetes and dyslipidemia.</p><p><strong>Conclusions: </strong>This study demonstrates that PHA can lead to resistant hypertension, highlighting the necessity for further research in this area.</p>\",\"PeriodicalId\":13969,\"journal\":{\"name\":\"International Journal of Endocrinology and Metabolism\",\"volume\":\"23 2\",\"pages\":\"e156728\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301664/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Endocrinology and Metabolism\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5812/ijem-156728\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Endocrinology and Metabolism","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5812/ijem-156728","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
摘要
背景:原发性醛固酮增多症(PHA)是继发性动脉高血压(AH)的常见病因,其特点是醛固酮自主分泌。它经常被误诊,甚至在手术干预后仍可能持续存在。目的:本研究旨在确定术前因素,以预测手术后高血压是否会持续或正常化,并概述相关的诊断特征。方法:我们在单中心进行了一项描述性、分析性、回顾性队列研究。该研究纳入了2014年12月至2023年8月期间在Mohamed The First University of Oujda (CERBO)附属医院的内分泌、糖尿病和营养科随访的PHA患者。回顾性收集了9年的患者记录数据,包括27例醛固酮与肾素比值(ARR)升高的PHA患者。6个月后持续性低钾血症和高血压(血压> 140/90 mm Hg)定义为持续性疾病。患者分为高血压完全消退组(A组)和持续高血压组(B组)。数据采用SPSS version 21进行分析。结果:患者平均年龄48.47±10.87岁,以女性为主(66.7%)。病因学评估发现70.4% (n = 19)的病例为康氏腺瘤,29.6% (n = 8)的病例为双侧肾上腺增生。51.9% (n = 14)的患者接受手术治疗,其中50% (n = 7)患者术后持续高血压,28.6% (n = 4)患者降压药减少。确定了持续高血压的两个预测因素:年龄bbbb50岁和高血压病程bbbb5年。术后高血压正常化的预测因素包括收缩压(SBP) < 140 mm Hg,舒张压(DBP) < 90 mm Hg,肾小球滤过率(GFR) > 90 mL/min/1.75 m2,糖尿病和血脂异常发生率低。结论:本研究表明PHA可导致顽固性高血压,这一领域有待进一步研究。
Evaluation of Predictive Risk Factors of Persistent Hypertension in Hyperaldosteronism After Surgery.
Background: Primary hyperaldosteronism (PHA) is a common cause of secondary arterial hypertension (AH), characterized by autonomous aldosterone secretion. It is frequently underdiagnosed and may persist even after surgical intervention.
Objectives: The present study aimed to identify preoperative factors that could predict whether hypertension would persist or normalize following surgery and to outline relevant diagnostic characteristics.
Methods: We conducted a descriptive, analytic, retrospective cohort study at a single center. The study included patients with PHA who were followed up at the Department of Endocrinology, Diabetology, and Nutrition in a hospital affiliated with Mohamed the First University of Oujda (CERBO), admitted between December 2014 and August 2023. Data were retrospectively collected from patient records over a 9-year period, involving 27 patients with PHA confirmed by an elevated aldosterone-to-renin ratio (ARR). Persistent disease was defined by persistent hypokalemia and hypertension (blood pressure > 140/90 mm Hg) after six months. Patients were divided into two groups: Those with complete resolution of hypertension (group A) and those with persistent hypertension (group B). Data were analyzed using SPSS version 21.
Results: The mean age of patients was 48.47 ± 10.87 years, with a female predominance (66.7%). The etiological assessment identified Conn's adenoma in 70.4% (n = 19) of cases and bilateral adrenal hyperplasia in 29.6% (n = 8). Surgery was performed in 51.9% (n = 14) of cases, with 50% (n = 7) maintaining persistent hypertension post-surgery, while 28.6% (n = 4) showed a reduction in antihypertensive medications. Two predictive factors for persistent hypertension were identified: Age > 50 years and hypertension duration > 5 years. Predictive factors for normalization of hypertension post-surgery included systolic blood pressure (SBP) < 140 mm Hg, diastolic blood pressure (DBP) < 90 mm Hg, glomerular filtration rate (GFR) > 90 mL/min/1.75 m2, and a low incidence of diabetes and dyslipidemia.
Conclusions: This study demonstrates that PHA can lead to resistant hypertension, highlighting the necessity for further research in this area.
期刊介绍:
The aim of the International Journal of Endocrinology and Metabolism (IJEM) is to increase knowledge, stimulate research in the field of endocrinology, and promote better management of patients with endocrinological disorders. To achieve this goal, the journal publishes original research papers on human, animal and cell culture studies relevant to endocrinology.