TITLErimary Aldosteronism in Diabetic Subjects with Resistant Hypertension

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TITLErimary Aldosteronism in Diabetic Subjects with Resistant Hypertension
标题： 伴有难治性高血压的糖尿病患者中的原发性醛固酮增多症

AUTHOR:作者： Guillermo E. Umpierrez, M.D., Paul Cantey, M.D., M.P.H., Dawn Smiley, M.D., Andres Palacio, M.D., Diana Temponi, M.D., Karen Luster, M.D. and Arlene Chapman, M.D

ABSTRACT摘要：

Background:背景：

Despite the high prevalence of hypertension in patients with type 2 diabetes, the prevalence of primary aldosteronism in this population has not been determined.尽管2型糖尿病患者中的高血压发病率较高，但这类人群中的原发性醛固酮增多症的发病率仍然未经确定。

Methods:方法： One hundred subjects with type 2 diabetes and resistant hypertension, defined as a blood pressure > 140/90 mm Hg despite the use of 3 antihypertensive agents, were screened for primary aldosteronism.对100名患有2型糖尿病及难治性高血压（定义为尽管使用了3种抗高血压药，但血压仍＞140/90 mm Hg）的参试者中的原发性醛固酮增多症进行筛选甄别。 Screening was performed by measuring plasma aldosterone (PAC)/plasma renin activity (PRA) ratio.所用的筛选甄别方法是测定血浆醛固酮（PAC）/血浆肾素活性（PRA）的比值。 Subjects with a PAC/PRA ratio >30 ng•ml-1•h-1 underwent confirmatory salt load testing.PAC/PRA比值＞30ng•ml-1•h-1的参试者接受了用于确诊的盐负荷试验。 Diagnostic criteria included a 24-hour urine aldosterone 12 mcg during the third day of oral salt load or a PAC 5 ng/dL after the 4-hour intravenous saline load.诊断标准包括：口服盐负荷试验的第3天里24小时的尿醛固酮为12mcg，或进行静脉盐负荷试验后4小时的PAC为5ng/dL。

Results:结果： Thirty four subjects had a PAC/PRA ratio >30 ng&#8226;ml-1&#8226;h-1. Fourteen subjects (14%, 95% CI:34名参试者的PAC/PRA比值＞30ng&#8226;ml-1&#8226;h-1。14名参试者（14%，置信度95%： 7.2-20.8) had a confirmed diagnosis of primary aldosteronism.7.2-20.8）确诊有原发性醛固酮增多症。 Ninety three patients were African Americans.93名患者为非洲裔美国人。 There were no differences in age, glycemic control, and number of antihypertensive drugs between subjects with and without primary aldosteronism.在患有原发性醛固酮增多症和没有该症的参试者之间，年龄、血糖控制以及抗高血压药的种类没有差异。 Subjects with primary aldosteronism had lower serum potassium (3.7 ± 0.4 vs. 4.0 ± 0.4 mmol/L, p = 0.012), higher PAC (15.6 ± 8 vs. 9.1 ± 6 ng/dL, p = 0.0016), and higher PAC/PRA (98 ± 74 vs. 21 ± 30 ng&#8226;mL-1&#8226;h-1, p<0.001) than patients without primary aldosteronism.患有原发性醛固酮增多症的参试者比没有原发性醛固酮增多症的患者具有较低的血钾（3.7±0.4对4.0±0.4mmol/L，p=0.012），较高的PAC（15.6±8对9.1±6ng/dL，p=0.0016），以及较高的PAC/PRA比值。

Conclusion:结论： Primary aldosteronism is common in diabetic patients with resistant hypertension, with a prevalence of 14%.原发性醛固酮增多症在伴有难治性高血压的糖尿病患者中常见，发病率为14%。 Our results indicate that diabetic subjects with poorly controlled hypertension on 3 antihypertensive drugs should be screened for primary aldosteronism.我们的研究结果表明，对那些伴有用3种抗高血压药均难以控制的高血压的糖尿病患者，应对其进行原发性醛固酮症筛选甄别。