Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2891_Библиотеки_им_академика_М_И_Перельмана

Resistant hypertension, defined as elevated blood pressure (BP) despite the concurrent use of three antihyper­tensive drug classes at maximum tolerated dose or controlled BP on four or more antihypertensive medications, affects approximately 15% of the hypertensive population. Primary aldosteronism (PA) is the most common secondary cause, accounting for up to 15% to 30% of the cases in a hypertension referral clinic setting.1 Even amongst the general hypertensive population, PA has a reported prevalence of 5% to 10%.1 PA is substantially under diagnosed due to lack of screening. One Italian study reported 992 diagnoses of PA during a 16-year period, corresponding to only 2% of the overall expected cases.2 Secondary analysis of the PATHWAY-2 study of resistant hypertension suggested that 25% of participants have previously undiagnosed aldosterone excess.3 The low detection rate is likely due to the lack of screening; only 7% of European primary care practitioners ever screened for PA using serum renin and aldosterone measurements4 and the rate of screening in the resistant hypertensive population was only 2% despite guidelines.