Impact of Primary Aldosteronism in Resistant Hypertension

Stavropoulos, Konstantinos; Imprialos, Κonstantinos; Patoulias, Dimitrios; Katsimardou, Alexandra; Doumas, Michael

doi:10.1007/s11906-022-01190-9

Cited by 4 publications

(5 citation statements)

References 85 publications

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“…Regarding surgical treatment, AVS-guided adrenalectomy still represents the best option for monolateral PA forms, because it can resolve RH in almost all patients with unilateral disease [78]. In a proof-of-concept study, Torresan et al showed the feasibility of AVS and adrenalectomy in 77 patients with PA-RH [79]: in all the 27 patients who showed a unilateral form, adrenalectomy resolved RH.…”

Section: Surgical and Pharmacological Treatment Of Pa In Rhmentioning

confidence: 99%

Primary Aldosteronism and Drug Resistant Hypertension: A “Chicken-Egg” Story

Lenzini

Pintus

Seccia

et al. 2023

Exp Clin Endocrinol Diabetes

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Drug-resistant arterial hypertension (RH) is a major risk factor for cardiovascular disease. However, it is often due to underlying causes, the identification of which poses significant clinical challenges because interfering drugs are used by definition in RH patients. In this setting, primary aldosteronism (PA) is a frequent cause of RH and its prevalence in RH patients is likely higher than 20%. The pathophysiological link between PA and the development and maintenance of RH involves target organ damage and the cellular and extracellular effects of aldosterone excess that promote pro-inflammatory and pro-fibrotic changes in the kidney and vasculature. The feasibility of adrenal vein sampling in RH patients, who have PA, and the clinical benefit achieved by adrenalectomy further emphasize the need of implementing the systematic screening for this common form of secondary hypertension in the management of a high-risk population as RH patients. We herein review the current knowledge of the factors that contribute to the RH phenotype with a focus on PA, and discuss the issues regarding the screening for PA in the setting of RH, and the therapeutical approaches (surgical and medical) aimed at resolving RH caused by PA.

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Section: Surgical and Pharmacological Treatment Of Pa In Rhmentioning

confidence: 99%

Primary Aldosteronism and Drug Resistant Hypertension: A “Chicken-Egg” Story

Lenzini

Pintus

Seccia

et al. 2023

Exp Clin Endocrinol Diabetes

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“…Cortisol excess contributes to impaired quality of life in PA sufferers through multiple co-morbidities, including depression/anxiety [ 65 , 66 , 67 , 68 , 69 , 70 ].…”

Section: Approach Of Connshing Syndromementioning

confidence: 99%

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Cârșote¹

2022

Diagnostics

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Connshing syndrome (CoSh) (adrenal-related synchronous aldosterone (A) and cortisol (C) excess) represents a distinct entity among PA (primary hyperaldosteronisms) named by W. Arlt et al. in 2017, but the condition has been studied for more than 4 decades. Within the last few years, this is one of the most dynamic topics in hormonally active adrenal lesions due to massive advances in steroids metabolomics, molecular genetics from CYP11B1/B2 immunostaining to genes constellations, as well as newly designated pathological categories according to the 2022 WHO classification. In gross, PA causes 4–10% of all high blood pressure (HBP) cases, and 20% of resistant HBP; subclinical Cushing syndrome (SCS) is identified in one-third of adrenal incidentalomas (AI), while CoSh accounts for 20–30% to 77% of PA subjects, depending on the tests used to confirm autonomous C secretion (ACS). The clinical picture overlaps with PA, hypercortisolemia being mild. ACS is suspected in PA if a more severe glucose and cardiovascular profile is identified, or there are larger tumours, ACS being an independent factor risk for kidney damage, and probably also for depression/anxiety and osteoporotic fractures. It seems that one-third of the PA-ACS group harbours mutations of C-related lines like PRKACA and GNAS. A novel approach means we should perform CYP11B2/CYP11B1 immunostaining; sometimes negative aldosteronoma for CYP11B1 is surrounded by micronodules or cell clusters with positive CYP11B1 to sustain the C excess. Pitfalls of hormonal assessments in CoSh include the index of suspicion (check for ACS in PA patients) and the interpretation of A/C ratio during adrenal venous sample. Laparoscopic adrenalectomy is the treatment of choice. Post-operative clinical remission rate is lower in CoSh than PA. The risk of clinically manifested adrenal insufficiency is low, but a synthetic ACTH stimulating testing might help to avoid unnecessary exposure to glucocorticoids therapy. Finally, postponing the choice of surgery may impair the outcome, having noted that long-term therapy with mineralocorticoids receptors antagonists might not act against excessive amounts of C. Awareness of CoSh improves management and overall prognosis.

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“…Hyperaldosteronism is common in patients with resistant hypertension and more than 20% of classical primary aldosteronism has been reported in resistant hypertension 30 . It has been revealed that excess aldosterone and constant intravascular volume expansion as shown by high levels of plasma natriuretic peptides frequently underlie resistant hypertension 7,31,32 .…”

Section: Resistant Hypertension Comorbiditiesmentioning

confidence: 99%

“…However, the prevalence of this is unknown. Secondary causes of resistant hypertension includes obstructive sleep apnea, renal parenchymal disease, primary aldosteronism and renal artery stenosis 28,32,35 . Uncommon secondary causes include Cushing's disease, intracranial tumour, pheochromocytoma, hyperparathyroidism and aortic coarctation.…”

Section: Secondary Causesmentioning

confidence: 99%

Resistant hypertension

Moke

Ekuerhare

Enaohwo

et al. 2022

J. Drug Delivery Ther.

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Background: Resistant hypertension is a common medical challenge facing clinicians and specialists. Although, the prevalence is currently unknown but various clinical trials have suggested that this problem is not rare. Resistant hypertension is blood pressure that remains above goal despite the use of at least three antihypertensive agents including a diuretic. It is a subtype of hypertension that increases the risk of cardiovascular, cerebrovascular and kidney disease. However, it is important to distinguish between pseudo-resistant hypertension and apparent hypertension from true resistant hypertension as they are often misdiagnosed. Objectives: This review focuses on resistant hypertension, its pathophysiology and established therapy. Methodology: Relevant articles used for this review covered a period of 2008-2022 using search engines and databases including PubMed, Scopus, Web of Science, and Google Scholar. Main observation: Evaluation of patients with true resistant hypertension includes appropriate blood pressure measurement, screening for causes of secondary hypertension and screening for interfering medications. Management of resistant hypertension that has proved successful includes non-pharmacological approach like lifestyle modification and optimization of pharmacological agents, often including the use of mineralocorticoid receptor antagonist. Conclusion: Considering the future management of resistant hypertension, a bunch of new device-based therapies are under effective development. Of these, renal denervation and carotid baroreflex activation are two potential devices for the significant reduction of blood pressure. However, further study is necessary before these devices can be approved for the routine treatment of resistant hypertension. Keywords: Aldosterone; Cardiovascular disease; Resistant Hypertension; Therapy.

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Impact of Primary Aldosteronism in Resistant Hypertension

Cited by 4 publications

References 85 publications

Primary Aldosteronism and Drug Resistant Hypertension: A “Chicken-Egg” Story

Primary Aldosteronism and Drug Resistant Hypertension: A “Chicken-Egg” Story

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Resistant hypertension

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