Discussion Of Index In Diagnosing Primary Aldosterinism And The Correlation Between Plasma Aldosterine Concentration With Cardiovascular-target-damages

Objective: To detect the values of plasma aldosterone concentration (PAC), plasma reninactivity（PRA）, and ARR in three positions in diagnosing primary aldosteronism (PA), as wellas investigating the correlation between PAC and left ventricular structure or pulse pressure.Methods: Continuously, after the treatment of two anti-hypertensions for two weeks, allsubjects whose blood pressure couldn’t be controlled bellow140/90mm Hg were recruited.After adjusting hypokalemia and influence of anti-hypertensive medicine, all subjectsunderwent assay of three positions and Intravenous saline load test, color dopplerechocardiography examination, or24-hour ambulatory blood pressure monitoring. Subjectswere carefully prepared from the pharmacological standpoint: stopping diuretic at least for6weeks, and dihydropyridin type of calcium antagonists, beta adrenergic receptor,angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, Alpha methyldopamine, clonidine and non-steroidal anti-inflammatory drugs for4weeks.Results:①The ROC area under the curve of PRA in there positions were0.5570.5330.514respevtively, no significance compared to the area under the reference line（P﹤0.05）. TheROC area under the curve of PAC and ARR in there positions were〔(0.6980.8180.822),(0.5450.6320.667), respevtively〕, significantly compared to the area under the reference line（P﹤0.05）; The optimum cutoff point of supine ARR and PAC were11.83,5.3, with(0.582,0.784，0.366,0.571),(0.818，0.725，0.543，0.411) in Se, Sp, YI and coincidence ratewith iv saline load test; Combining supine ARR and supine PAC produced a Se, Sp, YI andcoincident rate of0.476,0.941,0.471,0.857respectively.②IVST，LVPWT in increasedPAC group were higher than that in normal PAC group（P0.05)）. Bivariate correlationanalysis showed that PAC was weakly correlated with IVST（r＝0.190，P0.05）, whilewas not related to LVMI,LVPWT and LVEDD (P>0.05). Multiple linear stepwise regressionanalysis showed that PAC was positively correlated with IVST and LVPWT（respectively,β=0.206and β=0.241; all P0.05), but was not related to LVMI and LVEDD (P>0.05).③According to trisectors of mean PAC in three positions, subjects were divided into threegroups as follows: PAC.1, PAC.2and PAC.3. Pulse pressure in three groups had significance（P0.05）； Bivariate Spearman correlation analysis showed that mean PAC was correlatedwith pulse pressure（r=0.205，P＜0.05）; Multiple linear stepwise regression analysis showedthat mean PAC, HDL-c, and serum creatinine were associated with pulse pressure﹙β=0.418、-0.243、0.214，respectively, all P＜0.05）.Conclusions:①In the patients with serious hypokalemia, hypertension, cardiacinsufficiency and renal insufficiency who were unable to undergo iv saline load test, supineARR (≥11.83)combined with supine PAC(≥5.3ng/dl) could promote the diagnosis rate of PA.②Inhypertensives, after the treatment of two anti-hypertensions for two weeks,and whose blood pressure couldn’t be controlled bellow140/90mm Hg, PAC was positively correlatedwith IVST、LVPWT, suggesting that it was a risk factor of left ventricular structure changing③In hypertensives，after the treatment of two anti-hypertensions for two weeks,and whoseblood pressure couldn’t be controlled bellow140/90mm Hg, PAC was positively correlatedwith pulse pressure, suggesting that it was a risk factor of pulse pressure changing...