Resumo
Objetivo: Abordar os aspectos sobre o rastreio do Hiperaldosteronismo Primário (HAP) e discutir sobre a necessidade de abranger toda a população de hipertensos. Revisão Bibliográfica: O HAP possui uma elevada prevalência e dois principais subtipos. Sua relação com desfechos cardiovasculares desfavoráveis é grande, comparado aos hipertensos primários. O rastreio é uma estratégia importante pois o tratamento direcionado é capaz de reduzir significativamente os níveis pressóricos e o risco cardiovascular, por vezes até curar a hipertensão no tratamento cirúrgico, e melhorar o perfil bioquímico. Dessa forma, julgando os fatores mencionados e o seu custo-benefício, é importante que a realização do rastreio em toda a população de hipertensos seja considerada na prática da clínica médica. Considerações Finais: Embora a indicação para rastreio do HAP tenha grupos certos de pacientes, dado o risco aumentado de cada um, este trabalho mostra que o rastreio pode se estender à todas as hipertensões recém-diagnosticadas, dada a alta prevalência, bom custo-benefício e potencial de morbimortalidade do HAP.
Referências
LUBITZ CC, et al. Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients. Circ Cardiovasc Qual Outcomes, 2015; 8(6): 621-630.
YAMASHITA T, et al. Combination of urine pH and female gender for screening primary aldosteronism in newly diagnosed hypertensive patients. Nephrology Dialysis Transplantation, 2015; 30(3): iii92–iii101.
HANNEMANN A, et al. Screening for primary aldosteronism in hypertensive subjects: results from two German epidemiological studies. European Journal of Endocrinology, 2012; 167(1): 7–15.
JANSEN PM, et al. Aldosterone-to-renin ratio as a screening test for primary aldosteronism – the Dutch ARRAT Study. Netherlands The Journal of Medicine, 2008; 66(5): 220-228.
WEICKERT MO, et al. A reverse postural test as a screening tool for aldosterone-producing adenoma: a pilot study. Endocrine, 2009; 36(1): 75–82.
TOMASCHITZ A, PILZ S. Aldosterone to Renin Ratio – A Reliable Screening Tool for Primary Aldosteronism? Horm Metab Res, 2010; 42(6): 382–391.
WIDIMSKY J, et al. Prevalence of Primary Aldosteronism in a General Population Sample of Hypertensive Subjects. The Czech Post-Monica Study. Journal of Hypertension, 2019; 37(1): e219.
JAFFE G, et al. Screening Rates for Primary Aldosteronism in Resistant Hypertension: A Cohort Study. Hypertension, 2020; 75(3): 650-659.
KATER CE. Hiperaldosteronismo Primário. Arq Bras Endocrinol Metab, 2002; 46(1): 106-115.
FUNDER JW, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2016; 101(5): 1889-1916.
VILELA LAP, ALMEIDA MQ. Diagnosis and Management of primary aldosteronism. Arch Endocrinol Metab, 2017; 61(3): 305-312.
ROSSI GP. Primary Aldosteronism: JACC State-of-the-Art Review. J Am Coll Cardiol, 2019; 74(22): 2799-2811.
MONTORI VM, et al. Validity of the Aldosterone-Renin Ratio Used to Screen for Primary Aldosteronism. Mayo Clin Proc, 2001; 76(9): 877-882.
KLINE GA, et al. The Potential Role of Primary Care in Case Detection/ Screening of Primary Aldosteronism. American Journal of Hypertension, 2017; 30(12): 1147-1150.
SCHWARTZ GL, et al. Screening for Primary Aldosteronism: Implications of an Increased Plasma Aldosterone/Renin Ratio. Clinical Chemistry, 2002; 48(11): 1919-1923.
GURGENCI T, et al. Screening for Primary Aldosteronism – How to adjust existing antihypertensive medications to avoid diagnostic errors. Australian Journal of General Practice, 2020; 49(3): 127-131.
SCHWARTZ GL, TURNER ST. Screening for Primary Aldosteronism in Essential Hypertension: Diagnostic Accuracy of the Ratio of Plasma Aldosterone Concentration to Plasma Renin Activity. Clinical Chemistry, 2005; 51(2): 386-394.
VOLPE C, et al. Screening for primary aldosteronism in a primary care unit. Journal of the Renin-Angiotensin- Aldosterone System, 2013; 14(3) 212–219.
STOWASSER M. Primary Aldosteronism; Epidemiology and Screening. Encyclopedia of Endocrine Diseases. 2nd ed. Elsevier, 2019; 598-606.
MONTICONE S, et al. Primary Aldosteronism: Who Should be Screened?. Horm Metab Res, 2012; 44(3): 163-169.
WIDIMSKY J, et al. Primary aldosteronism in a general population sample. The Czech post-MONICA study. Blood Pressure, 2020; 29(3): 191-198.
YAMASHITA T, et al. Screening of primary aldosteronism by clinical features and daily laboratory tests: combination of urine pH, sex, and serum K. J Hypertens, 2018; 36(2): 326-334.
WILLIAMS TA, REINCKE M. Diagnosis and management of primary aldosteronism: the Endocrine Society guideline 2016 revisited. European Journal of Endocrinology, 2018; 179(1): 19-29.
ROSSI GP, et al. The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism. International Journal of Cardiology Hypertension, 2020; 15(5): 100029.
CAPELETTI JT, et al. Hiperaldosteronismo primário: diagnóstico e complicações clínicas. Rev Bras Hipertens, 2009; 16(1): 65-58.
MULATERO P, et al. Guidelines for primary aldosteronism: Uptake by primary care physicians in Europe. Journal of Hypertension, 2016; 34(11): 2253-2257.
NISHIKAWA T, et al. Guidelines for the diagnosis and treatment of primary aldosteronism – The Japan Endocrine Society 2009. Endocrine Journal, 2011; 58(9): 711-721.
BARROSO WKS, et al. Diretriz Brasileira de Hipertensão Arterial – 2020. Arq Bras Cardiol, 2021; 116(3): 516-658.
