Evidence of Primary Aldosteronism in a Predominantly Female Cohort of Normotensive Individuals: A Very High Odds Ratio for Progression into Arterial Hypertension

2013 ◽  
Vol 98 (4) ◽  
pp. 1409-1416 ◽  
Author(s):  
Athina Markou ◽  
Theodora Pappa ◽  
Gregory Kaltsas ◽  
Aggeliki Gouli ◽  
Kostas Mitsakis ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Odds Ratio ◽  
High Odds ◽  
High Odds Ratio ◽  
Predominantly Female ◽  
Very High ◽  
Female Cohort

Poor social support and loneliness in chronic headache: Prevalence and effect modifiers

Cephalalgia ◽  
2021 ◽  
pp. 033310242110203
Author(s):  
Maria Lurenda Westergaard ◽  
Cathrine Juel Lau ◽  
Karen Allesøe ◽  
Anne Helms Andreasen ◽  
Rigmor Højland Jensen
Keyword(s):  
Social Support ◽  
Odds Ratio ◽  
Chronic Headache ◽  
Medication Overuse ◽  
Odds Ratios ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Self Rated Health ◽  
Poor Social Support ◽  
Very High

Objective To explore the prevalence of poor social support and loneliness among people with chronic headache, and how these might be effect modifiers in the relationships between chronic headache and stress, medication overuse, and self-rated health. Background Poor social support and loneliness are consistently linked to worse health outcomes. There are few epidemiologic studies on their effect on headache. Methods The Danish Capital Region Health Survey, a cross-sectional survey, was conducted in 2017. Participants were asked about headache, pain medication use, social support, loneliness, perceived stress, and self-rated health. Data were accessed from sociodemographic registers. Logistic regression analyses were performed to test for effect modification. Results The response rate was 52.6% (55,185 respondents) and was representative of the target population. People with chronic headache were more likely to report poor social support and loneliness compared to those without chronic headache ( p < 0.0001 for both). Odds ratios for the combination of chronic headache and poor social support were very high for stress (odds ratio 8.1), medication overuse (odds ratio 21.9), and poor self-rated health (odds ratio 10.2) compared to those without chronic headache and with good social support. Those who reported both chronic headache and loneliness had a very high odds ratio for stress (odds ratio 14.4), medication overuse (odds ratio 20.1), and poor self-rated health (odds ratio 15.9) compared to those without chronic headache and low loneliness score. When adjusted for sociodemographic factors, poor social support and loneliness were not significant effect modifiers in almost all these associations. Loneliness was a significant effect modifier in the association between chronic headache and medication overuse, but exerted greater effect among those who did not report they were lonely. Conclusion Poor social support and loneliness were prevalent among people with chronic headache. The combination of chronic headache and poor social support or loneliness showed higher odds ratios for stress, medication overuse, and poor self-rated health compared to those with good social support and low loneliness scores. The effect of loneliness in the relationship between chronic headache and medication overuse warrants further study.

Clinical Score and Machine Learning-Based Model to Predict Diagnosis of Primary Aldosteronism in Arterial Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (5) ◽  
pp. 1595-1604
Author(s):  
Fabrizio Buffolo ◽  
Jacopo Burrello ◽  
Alessio Burrello ◽  
Daniel Heinrich ◽  
Christian Adolf ◽  
...  
Keyword(s):  
Machine Learning ◽  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Learning Algorithm ◽  
Area Under The Curve ◽  
Clinical Score ◽  
Machine Learning Algorithms ◽  
Supervised Machine Learning ◽  
Individual Risk ◽  
The Individual

Primary aldosteronism (PA) is the cause of arterial hypertension in 4% to 6% of patients, and 30% of patients with PA are affected by unilateral and surgically curable forms. Current guidelines recommend screening for PA ≈50% of patients with hypertension on the basis of individual factors, while some experts suggest screening all patients with hypertension. To define the risk of PA and tailor the diagnostic workup to the individual risk of each patient, we developed a conventional scoring system and supervised machine learning algorithms using a retrospective cohort of 4059 patients with hypertension. On the basis of 6 widely available parameters, we developed a numerical score and 308 machine learning-based models, selecting the one with the highest diagnostic performance. After validation, we obtained high predictive performance with our score (optimized sensitivity of 90.7% for PA and 92.3% for unilateral PA [UPA]). The machine learning-based model provided the highest performance, with an area under the curve of 0.834 for PA and 0.905 for diagnosis of UPA, with optimized sensitivity of 96.6% for PA, and 100.0% for UPA, at validation. The application of the predicting tools allowed the identification of a subgroup of patients with very low risk of PA (0.6% for both models) and null probability of having UPA. In conclusion, this score and the machine learning algorithm can accurately predict the individual pretest probability of PA in patients with hypertension and circumvent screening in up to 32.7% of patients using a machine learning-based model, without omitting patients with surgically curable UPA.

scholarly journals PRIMARY ALDOSTERONISM: THE RESULTS OF THE TREATMENT ACCORDING TO THE DATA OF RENAL ARTERIES DUPLEX SCANNING

World Science ◽  
2019 ◽  
Vol 2 (4(44)) ◽  
pp. 16-21
Author(s):  
Zubryk I. V.
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Renal Artery ◽  
Primary Aldosteronism ◽  
Reference Range ◽  
Renal Arteries ◽  
Duplex Scanning ◽  
Aldosterone Level ◽  
Before And After ◽  
Segmental Arteries

In the structure of arterial hypertension, primary aldosteronism (РА) ranges from 5 to 15%. Changes in intrarenal hemodynamics are due to both high blood pressure and direct aldosterone level. The purpose of the study was to analyze the results of PA treatment according to ultrasound doppler scanning of renal arteries. In general, 55 patients with PA were treated. Renal arteries duplex scanning before and after the treatment was performed in 20 patients. During treatment, the normalization of Vps, Ved, S/D, PI, PI, AT, TAMX indices was recorded in patients. The RI of the interlobar arteries slightly increased, however, it remained within the reference range. The reduction of aldosterone levels led to increase of TAMX index at the level of the renal artery trunk, S/D, RI and decrease in AT at the level of the segmental arteries, as well as increase of Ved and S/D at the level of the interlobar arteries.

scholarly journals SAT-564 Effectiveness of Treatment with Mineralocorticoid Receptor Antagonistsin Primary Aldosteronism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Yuta Tezuka ◽  
Adina Turcu
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Primary Aldosteronism ◽  
Odds Ratio ◽  
Mineralocorticoid Receptor ◽  
Beta Blockers ◽  
Multiple Logistic Regression Analysis ◽  
Multiple Logistic Regression ◽  
Low Renin Hypertension

Abstract Background: Medical treatment with mineralocorticoid receptor antagonists (MRAs) is preferred for patients with primary aldosteronism (PA) who are not surgical candidates. Adequate mineralocorticoid receptor blockade, as suggested by renin elevation above suppression levels, has been associated with lower rates of cardiovascular and renal complications as compared with PA with sustained renin suppression. Objectives: To assess the timeline and rates of achieving target renin levels in patients with PA and low renin hypertension treated with MRAs. Patients and Methods: We conducted a retrospective cohort study of adult patients with hypertension who were treated with MRAs in an academic center between 2003-2019. Of these, we included patients who had suppressed renin at baseline, and repeated renin measurement(s) during MRAs therapy. Renin suppression was defined as plasma renin activity (PRA) 1.0 ng/mL/h or direct renin concentration (DRC) 8.0 pg/mL. We excluded patients with adrenal cancer, end-stage renal disease, exogenous glucocorticoids, and critically ill. Mann-Whitney test, Wilcoxon signed rank test, Chi-Square test and multiple logistic regression analysis were employed, as appropriate. Results: So far, 89 patients (45 men), median age 56 (range, 19-84), have been included. Of these, 46% had confirmed PA; 25% had positive PA screening, but no confirmatory tests; and 29% had other forms of low-renin hypertension. On average, patients were on 2.9 1.6 antihypertensive agents; 62% of patients were prescribed beta blockers, and 38% were on K+ supplements. Overall, renin (PRA in 69 cases, and DRC in 20 cases) increased after MRA treatment (from 0.40 [0.10, 0.60] ng/mL/h to 1.10 [0.60, 2.23] ng/mL/h; and from 2.1 [2.1, 3.7] pg/mL to 5.7 [2.9, 16.7] pg/mL, respectively, p&lt;0.0001 for both). The cumulative proportions of patients in whom renin reached target levels during MRA treatment were: 25% at 2 weeks; 38.9% at 1 month; 34.2% at 3 months; 39.5% at 6 months; and 47.2% at 1 year. Age, sex, race, blood pressure, use of beta blockers, renal function, serum K+ and aldosterone concentrations were similar between patients with target vs. suppressed renin. Multiple logistic regression analysis suggested that after adjusting for age and sex, higher MRA dose and higher BMI were associated with higher likelihood of achieving target renin during MRA therapy (odds ratio (95%CI): 1.021 (1.001-1.041) and 1.097 (1.008-1.193), respectively, p&lt;0.05 for both); conversely, beta blockers use tended to be less often associated with target renin (odds ratio, 0.37 (0.13-1.008), p=0.052). Conclusion: Although raising renin above suppression levels is important for reducing the cardiovascular risk associated with PA, this goal is achieved in less than half of patients, even after one year of treatment with MRAs, in an academic setting. Strategies for optimizing PA treatment are critically needed.

Prevalence of Primary Aldosteronism Across the Stages of Hypertension Based on a New Combined Overnight Test

2021 ◽  
Vol 53 (07) ◽  
pp. 461-469
Author(s):  
Nick Voulgaris ◽  
Ernestini Tyfoxylou ◽  
Sophia Vlachou ◽  
Evagelia Kyriazi ◽  
Chris Gravvanis ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Adrenocorticotropic Hormone ◽  
Stage I ◽  
Aldosterone Secretion ◽  
Hypertensive Patients ◽  
True Prevalence ◽  
Normal Limits ◽  
Aldosterone To Renin Ratio ◽  
A Prospective Study

AbstractPrimary aldosteronism (PA) is the most common endocrine cause of arterial hypertension. Despite the increasing incidence of hypertension worldwide, the true prevalence of PA in hypertension was only recently recognized. The objective of the work was to estimate the prevalence of PA in patients at different stages of hypertension based on a newly developed screening-diagnostic overnight test. This is a prospective study with hypertensive patients (n=265) at stage I (n=100), II (n=88), and III (n=77) of hypertension. A group of 103 patients with essential hypertension without PA was used as controls. PA diagnosis was based on a combined screening-diagnostic overnight test, the Dexamethasone-Captopril-Valsartan Test (DCVT) that evaluates aldosterone secretion after pharmaceutical blockade of angiotensin-II and adrenocorticotropic hormone. DCVT was performed in all participants independently of the basal aldosterone to renin ratio (ARR). The calculated upper normal limits for post-DCVT aldosterone levels [3 ng/dl (85 pmol/l)] and post-DCVT ARR [0.32 ng/dl/μU/ml (9 pmol/IU)] from controls, were applied together to establish PA diagnosis. Using these criteria PA was confirmed in 80 of 265 (30%) hypertensives. The prevalence of PA was: 21% (21/100) in stage I, 33% (29/88) in stage II, and 39% (30/77) in stage III. Serum K+ levels were negatively correlated and urinary K+ was positively correlated in PA patients with post-DCVT ARR (r=–0.349, p <0.01, and r=0.27, p <0.05 respectively). In conclusion, DCVT revealed that PA is a highly prevalent cause of hypertension. DCVT could be employed as a diagnostic tool in all subjects with arterial hypertension of unknown cause.

scholarly journals High geographic prevalence of pulmonary artery hypertension: associations with ethnicity, drug use, and altitude

2020 ◽  
Vol 10 (1) ◽  
pp. 204589401989453
Author(s):  
Jason Dubroff ◽  
Lana Melendres ◽  
Yan Lin ◽  
Daniel Raley Beene ◽  
Loren Ketai
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Odds Ratio ◽  
Disease Burden ◽  
Drug Exposure ◽  
Geographic Area ◽  
Hypertension Prevalence ◽  
Hypertension Clinic ◽  
Hispanic Patients ◽  
Pulmonary Arterial

While estimates of pulmonary arterial hypertension incidence and prevalence commonly range from 1–3/million and 15–25/million, respectively, clinical experience at our institution suggested much higher rates. We sought to describe the disease burden of pulmonary arterial hypertension in the geographic area served by our Pulmonary Hypertension Clinic and compare it to the REVEAL registry. Our secondary objectives were to document pulmonary arterial hypertension prevalence in minorities underrepresented in REVEAL (Hispanics and Native Americans) and to address the association of pulmonary arterial hypertension with exposure to drugs and moderately increased residential altitude in this population. Retrospective review of pulmonary arterial hypertension clinic patients alive during 2016 identified 154 patients. Hispanic patients made up 35.7% of the cohort, a much greater percentage than REVEAL, p < .001 but smaller than the percentage of Hispanic patients (48.4%) in geographic area served by the clinic. Pulmonary arterial hypertension due to drug exposure was more common and idiopathic pulmonary arterial hypertension was less common than in REVEAL ( p < .001). Overall, pulmonary arterial hypertension incidence was 14 cases per million, greater than the REVEAL registry, odds ratio 6.3 (95% CI: 4.2–9.5), ( p < .001). Annual period prevalence of pulmonary arterial hypertension was 93 cases per million, also greater than the REVEAL, odds ratio = 7.5 (95% CI: 6.4–8.8) and remained greater when the clinic cohort was constrained to patients with hemodynamic severity comparable to REVEAL, odds ratio = 3.8 (95% CI: 3.0–4.6), ( p < .001). There was a strong association between pulmonary arterial hypertension prevalence and residence at altitude > 4000 ft, odds ratio = 26.6 (95% CI: 8.5–83.5), p < .001; however, this was potentially confounded by pulmonary arterial hypertension treatment referral patterns. These findings document a much higher local pulmonary arterial hypertension incidence and prevalence than previously reported in REVEAL. While population ethnicity differed markedly from REVEAL, the disease burden was not driven by these differences. The possible association of moderately increased residential altitude with pulmonary arterial hypertension warrants further evaluation.

scholarly journals CARDIO-ANKLE VASCULAR INDEX (CAVI) AND ARTERIAL STIFFNESS ASSESSMENT AT MEDICAL PREVENTION DEPARTMENTS AND UNITS

2014 ◽  
Vol 13 (1) ◽  
pp. 40-43
Author(s):  
R. M. Linchak ◽  
R. M. Komkov ◽  
O. G. Prishchepa ◽  
O. B. Shvabskaya
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Prognostic Models ◽  
Medical Prevention ◽  
Clinical Potential ◽  
Preventive Examination ◽  
Very High ◽  
Score Index

Aim. To study the clinical potential and feasibility of the assessment of cardio-ankle vascular index (CAVI) at medical prevention departments and units.Material and methods. The study included 66 patients (13 men and 53 women; mean age 52,26±11,2 years) with very low to very high total cardiovascular risk (CVR) levels and SCORE index 0–25% (mean SCORE index 3,18±4,34%), who underwent volume sphygmography and automatic CAVI measurement.Results. There was a moderately strong, statistically significant correlation between CAVI and age; CAVI and systolic blood pressure (SBP); and CAVI and SCORE. While higher CAVI values were observed among non-smokers and patients with arterial hypertension, these differences were not statistically significant.Conclusion. As a method for arterial stiffness assessment, CAVI measurement is easy to perform, does not require any special preparation, and can be used at medical prevention departments and units as a part of a more detailed preventive examination. A moderately strong, statistically significant correlation was observed between CAVI and SCORE, as well as between CAVI and such SCORE components as age and SBP. However, further research is needed in order to clarify the possibility of CAVI inclusion in prognostic models.

scholarly journals Cardiovascular risk in petrochemical workers

2020 ◽  
Vol 99 (5) ◽  
pp. 498-503
Author(s):  
Zulfiya F. Gimaeva ◽  
I. V. Bukhtiyarov ◽  
A. B. Bakirov ◽  
V. A. Kaptsov ◽  
L. K. Karimova
Keyword(s):  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
Working Conditions ◽  
Preventive Measures ◽  
Left Ventricular ◽  
Working Environment ◽  
Labor Process ◽  
Risk Of Death ◽  
High Prevalence ◽  
Very High

Introduction. The high prevalence of diseases of the circulatory system of workers in various sectors of the economy, the lack of data on the effects of harmful production factors on the formation of cardiovascular diseases in petrochemical industry workers justify the importance of conducting special studies on these petrochemical complex plants with the aim of assessing cardiovascular risk with the subsequent development of preventive measures. Material and methods. The objects of the study were workers in the production of monomers (ethylene, propylene, ethylbenzene, isoprene, divinyl) of petrochemical enterprises. Hygienic studies of the working conditions of workers included an assessment of the factors of the working environment and the labor process using generally accepted methods. Comprehensive clinical examination of workers included periodic examinations (n = 2634) with calculation of total and relative cardiovascular risk using the SCORE system, using questionnaire data, a Reeder L questionnaire and an in-depth clinical diagnostic medical examination (n = 101) with the definition total cardiovascular risk. Results. The most significant occupational factors of the labor process for workers in the main profession - panmen were established to include the combination of a chemical factor with the occupational noise and labor intensity, with an overall assessment of working conditions 3.2. The class of working conditions of workers of the comparison group (locksmith in instrumentation and automation corresponds to the permissible). There were revealed a high prevalence of arterial hypertension and other factors of cardiovascular risk. A higher dependence of the arterial hypertension level on age and length of service in the group of panmen was established when compared to the mechanicians of instrumentation and automation. Using mathematical models of multiple regression, the likely dynamics of the level of arterial hypertension and the left ventricular myocardial mass index were calculated under the influence of increasing age and other risk predictors. Conclusion. The results of a clinical study showed workers with severe arterial hypertension, a high and very high risk of death from cardiovascular disease on the SCORE scale, a high and very high overall cardiovascular risk, signs of dyslipidemia, obesity, high stress levels to require close attention. It is important to timely diagnose lesions of target organs, to conduct rational prevention aimed at reducing risk factors. According to the results of the study, there were developed preventive measures aimed at reducing cardiovascular morbidity and cardiovascular risk, prolonging the longevity of workers in petrochemical industries.

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