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    Home > Active Ingredient News > Endocrine System > Guidelines/consensus interpretation for primary aldosteronism

    Guidelines/consensus interpretation for primary aldosteronism

    • Last Update: 2021-05-09
    • Source: Internet
    • Author: User
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    Introduction: On April 23, 2021, the "Twelfth National Symposium on Progress in Endocrine and Metabolic Diseases" was held in Baoding.
    At this meeting, Professor Dou Jingtao from the Endocrinology Department of the First Medical Center of the Chinese People's Liberation Army General Hospital A wonderful academic report was given on the topic of "Guidelines for Hyperaldosteronism/Consensus Interpretation".

    Expert introduction Professor Dou Jingtao, chief physician, professor, and doctoral supervisor of the Endocrinology Department of the First Medical Center of PLA General Hospital, member of the Standing Committee of the Diabetes Branch of the Chinese Medical Association, and leader of the Diabetes Metabolic Macrovascular Disease Group (preparatory), and the Diabetes Branch of the Beijing Medical Association The chairman-elect, Professor Dou, a member of the Standing Committee of the Endocrinology and Metabolism Professional Committee of the PLA Medical Science and Technology Committee, first introduced the definition, clinical manifestations and epidemiological data of primary aldosteronism (primary aldehyde), and then the subjects and methods of primary aldehyde screening , Diagnosis experiments, classification, treatment methods, etc.
    , compared and interpreted domestic and foreign guidelines/consensus.

    Primary aldehyde is not benign hypertension.
    The more serious damage.
    Primary aldehyde is defined as the adrenal cortex autonomously secretes aldosterone, leading to sodium retention and potassium excretion in the body, blood volume increases, renin-angiotensin system activity is inhibited, and the main clinical manifestation is hypertension.
    And hypokalemia.

    Excessive aldosterone is an important risk factor leading to myocardial hypertrophy, heart failure and impaired renal function.
    Compared with patients with essential hypertension, patients with primary aldehydes have more serious damage to the target organs of hypertension such as the heart and kidneys.
    From Taiwan, my country Provincial research shows that at the same blood pressure level, patients with primary aldehydes have an increased risk of stroke by 2.
    2-4.
    2 times; risk of arrhythmia increased by 5.
    0-12.
    1 times; risk of heart failure increased by 2.
    9-10.
    3.
    Times.

    Therefore, the early diagnosis and early treatment of primary aldehydes are very important.

    The prevalence of primary aldehyde in hypertensive population exceeds 5%.
    According to foreign reports, among patients with grade 1, 2, and 3 hypertension, the prevalence of primary aldehyde is 1.
    99%, 8.
    02% and 13.
    2%, respectively; Among patients with hypertension, the prevalence rate is even higher, about 17%~23%.

    Among Asian people with common hypertension, the prevalence rate is about 5%.

     In 2010, led by the Endocrinology Branch of the Chinese Medical Association, 1656 patients with refractory hypertension were screened for primary aldehyde in 19 centers in 11 provinces across the country, and the prevalence rate was 7.
    1%.

    Research published by Professor Li Qifu’s team showed that the incidence of primary aldehydes in newly diagnosed hypertension exceeds 4.
    0%.

     Taken together, the prevalence of primary aldehydes in people with hypertension is 5%-10%.

     Interpretation and comparison of domestic and foreign guidelines/consensus Next, Professor Dou will comment on the 2020 China CSE Consensus, the 2020 European Society of Hypertension Consensus, and the 2017 Taiwan Province in terms of screening objects, methods, diagnosis experiments, classification and treatment options.
    Consensus and the 2016 U.
    S.
    Guidelines have been interpreted and compared.

    1.
    Screening targets Table 1 Screening targets Professor Dou pointed out that in terms of screening targets, the consensus of our country is very different from foreign guidelines in that our country includes newly diagnosed hypertensive patients into the primary aldehyde screening population, this is because In my country, the incidence of primary aldehydes in newly diagnosed hypertension has exceeded 4.
    0%.

    2.
    Screening methods and influencing factors control 1.
    Screening methods and cut-off points are mainly radioimmunoassay and chemiluminescence immunoassay to detect ARR.

    However, each version of the guidelines and consensus has different entry points.

    Table 2 ARR positive cut-off points recommended by different guidelines/consensus 2.
    Controlling factors affecting age, gender, diet, medication, body position, serum potassium and creatinine, etc.
    may affect the ARR value, leading to false positive or false negative results, especially Need to pay attention to the drugs used.

    Table 3 Reasons for false positives or false negatives of ARR Regarding the influence of drugs on the screening results, the consensus in my country proposes: 1.
    Discontinue drugs that have a greater impact on ARR for at least 4 weeks, including aldosterone receptor antagonists and potassium-sparing diuretics , Potassium excretion diuretics. 2.
    Drugs such as ACEI and ARB can increase renin activity and reduce aldosterone, leading to false negative ARR.

    Therefore, it is necessary to stop the above-mentioned drugs for at least 2 weeks and test again.

    Recommendations for drugs that have little impact on the screening results (renin-angiotensin system) are shown in the table below.

    Table 4 Recommendations for the selection of antihypertensive drugs in different guidelines (with little impact on screening results) 3.
    Confirmation tests and standard confirmation tests now include normal saline test, captopril test, oral high sodium diet and fludrocortisone test.

    Due to the limitations of materials and operation, the latter two tests are less clinically used, and the physiological saline test and captopril test are used more.
    At present, the most controversial in the various guidelines/consensus is the captopril test.

    Table 5 Recommended differences in captopril test.
    In other confirmatory tests, Taiwan Province has launched a 24-hour urine aldosterone test and a randomized aldosterone/creatinine test.

    Japan still uses furosemide to stimulate the body position test.

    4.
    Classification method At present, the imaging classification is still recognized at home and abroad: CT of the adrenal glands.

    Table 6 Differences of primary aldehyde typing methods Professor Dou pointed out that the immunohistochemistry of adrenal gland specimens proposed by Taiwan Province can be used for typing, which can explore the pathogenesis and characteristics of primary aldehydes and provide a powerful reference for future diagnosis and typing.
    , Can learn from.

    V.
    Differences in the selection of treatment methods Table 7 Summary of differences in the selection of treatment methods After interpreting and comparing the various versions of the guidelines, Professor Dou Jingtao concluded that the understanding of the guidelines/consensus should be: 1.
    Recognize its limitations.

    The guidelines/consensus are time-sensitive and different in different generations, so they should be updated continuously.

    2.
    Recognize regionality.

    Different countries have different inspection and treatment methods, so it is necessary to "adjust measures to local conditions" in accordance with national conditions.

    3.
    The composition of experts in the cognitive guide/consensus writing.

    Surgeons write guidelines to advocate surgery, and endocrinologists write consensus to advocate conservative treatment.

    This is a major reason for the differences between different guidelines.
    In future medical services, collaboration and communication between departments should be strengthened.
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