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Buffolo F, Pecori A, Reincke M, Outland M, Veglio F, Schwarzlmüller P, Bidlingmaier M, Kunz S, Stremmel C, Mengozzi G, Priolo G, Mulatero P, Adolf C, Monticone S. Long-Term Follow-Up of Patients With Elevated Aldosterone-to-Renin Ratio but Negative Confirmatory Test: The Progression of Primary Aldosteronism Phenotypes. Hypertension 2024; 81:340-347. [PMID: 38084587 DOI: 10.1161/hypertensionaha.123.21983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/16/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND About 10% of patients with arterial hypertension have a positive screening test for primary aldosteronism (PA) and 50% to 70% of them have a negative confirmatory test: the appropriate follow-up of these patients is currently unknown. We investigated the incidence of PA in patients with previous negative confirmatory testing, after at least a 2-year follow-up. METHODS One hundred eighty-four patients with a previously elevated aldosterone-to-renin ratio followed by a negative confirmatory test were recruited in 2 hypertension centers (Torino and Munich). We repeated the screening test for PA and, if positive, the confirmatory test (seated saline infusion test or captopril challenge test). Primary end point of the study was the incidence of newly diagnosed overt PA, as defined by a positive confirmatory test. RESULTS After a mean follow-up of 5 years, 20% of patients developed overt PA. When subtype diagnosis was offered systematically, one-third of patients displayed unilateral PA. Patients who developed PA showed worsening of blood pressure control and a higher rate of cardiac organ damage, despite similar implementation of antihypertensive therapy, compared with patients without PA. A mild progression of autonomous aldosterone secretion was evident even in patients without confirmed PA but with relatively stable control of blood pressure levels over time. CONCLUSIONS About one-fifth of patients with a negative confirmatory test develop overt PA over time. A clinical follow-up of patients with a negative confirmatory test is advisable, along with the repetition of PA investigation, primarily in patients with worsening of blood pressure control.
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Affiliation(s)
- Fabrizio Buffolo
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (F.B., A.P., F.V., P.M., S.M.), University of Torino, Italy
| | - Alessio Pecori
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (F.B., A.P., F.V., P.M., S.M.), University of Torino, Italy
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Merve Outland
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Franco Veglio
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (F.B., A.P., F.V., P.M., S.M.), University of Torino, Italy
| | - Paul Schwarzlmüller
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sonja Kunz
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christopher Stremmel
- Medizinische Klinik und Poliklinik I (C.S.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Giulio Mengozzi
- Department of Laboratory Medicine (G.M., G.P.), University of Torino, Italy
| | - Gabriella Priolo
- Department of Laboratory Medicine (G.M., G.P.), University of Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (F.B., A.P., F.V., P.M., S.M.), University of Torino, Italy
| | - Christian Adolf
- Medizinische Klinik und Poliklinik IV, Department of Medicine IV (M.R., M.O., P.S., M.B., S.K., C.A.), Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Silvia Monticone
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (F.B., A.P., F.V., P.M., S.M.), University of Torino, Italy
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De Filippo O, D'Ascenzo F, Iannaccone M, Bertaina M, Leone A, Borzillo I, Ravetti E, Solano A, Pagliassotto I, Nebiolo M, Bruno F, Giacobbe F, Muscoli S, Monticone S, Brizzi MF, Biondi Zoccai G, De Ferrari GM. Safety and efficacy of bempedoic acid: a systematic review and meta-analysis of randomised controlled trials. Cardiovasc Diabetol 2023; 22:324. [PMID: 38017541 PMCID: PMC10685600 DOI: 10.1186/s12933-023-02022-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND AND AIMS Bempedoic Acid (BA) is a novel Lipid-Lowering Therapy (LLT). We performed a systematic review and meta-analysis to assess the efficacy and safety of BA in patients with hypercholesterolemia. METHODS PubMed, Scopus, and Cochrane library databases were searched for randomised controlled trials evaluating the efficacy and/or safety of BA compared with placebo. Trials investigating dosages other than 180 mg/die were excluded. Major adverse cardiovascular events (MACE) were the primary efficacy endpoint. LDL-cholesterol reduction was the primary laboratory endpoint. Pre-specified safety endpoints included muscle-related adverse events, new-onset diabetes, and gout. The protocol was registered on PROSPERO (temporary ID:399,867). RESULTS Study search identified 275 deduplicated results. 11 studies, encompassing 18,315 patients (9854 on BA vs 8461 on placebo/no treatment) were included. BA was associated with a reduced risk of MACE (OR 0.86, 95% CI 0.79-0.95), myocardial infarction (OR 0.76, 95% CI 0.64-0.88) and unstable angina (OR 0.69, 95% CI 0.54-0.88) compared to control, over a median follow up of 87 (15-162) weeks. BA was associated with a reduction of LDL-Cholesterol (mean difference [MD]-22.42,95% CI - 24.02% to - 20.82%), total cholesterol (- 16.50%,95% - 19.21% to - 13.79%), Apo-B lipoprotein (- 19.55%, - 22.68% to - 16.42%) and high-sensitivity CRP (- 27.83%, - 31.71% to - 23.96%) at 12 weeks. BA was associated with a higher risk of gout (OR 1.55, 95% CI 1.27-1.90) as compared with placebo. Efficacy on laboratory endpoints was confirmed, with a variable extent, across patients on statin or ezetimibe background therapy. CONCLUSIONS The improved cholesterol control achieved with BA translates into a reduced risk of MACE, including myocardial infarction and coronary revascularisation. The drug has a satisfactory safety profile except for an increased risk of gout.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città Della Salute e Della Scienza" Hospital, Turin, Italy.
- Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126, Turin, Italy.
| | - Mario Iannaccone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città Di Torino, Turin, Italy
| | - Maurizio Bertaina
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città Di Torino, Turin, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Irene Borzillo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Emanuele Ravetti
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Andrea Solano
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Ilaria Pagliassotto
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Marco Nebiolo
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
| | - Federico Giacobbe
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Saverio Muscoli
- Division of Cardiology, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Silvia Monticone
- Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126, Turin, Italy
| | - Maria Felice Brizzi
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, "Città Della Salute e Della Scienza" Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Corso Bramante 88, 10126, Turin, Italy
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Blaser MC, Buffolo F, Halu A, Turner ME, Schlotter F, Higashi H, Pantano L, Clift CL, Saddic LA, Atkins SK, Rogers MA, Pham T, Vromman A, Shvartz E, Sukhova GK, Monticone S, Camussi G, Robson SC, Body SC, Muehlschlegel JD, Singh SA, Aikawa M, Aikawa E. Multiomics of Tissue Extracellular Vesicles Identifies Unique Modulators of Atherosclerosis and Calcific Aortic Valve Stenosis. Circulation 2023; 148:661-678. [PMID: 37427430 PMCID: PMC10527599 DOI: 10.1161/circulationaha.122.063402] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/02/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Fewer than 50% of patients who develop aortic valve calcification have concomitant atherosclerosis, implying differential pathogenesis. Although circulating extracellular vesicles (EVs) act as biomarkers of cardiovascular diseases, tissue-entrapped EVs are associated with early mineralization, but their cargoes, functions, and contributions to disease remain unknown. METHODS Disease stage-specific proteomics was performed on human carotid endarterectomy specimens (n=16) and stenotic aortic valves (n=18). Tissue EVs were isolated from human carotid arteries (normal, n=6; diseased, n=4) and aortic valves (normal, n=6; diseased, n=4) by enzymatic digestion, (ultra)centrifugation, and a 15-fraction density gradient validated by proteomics, CD63-immunogold electron microscopy, and nanoparticle tracking analysis. Vesiculomics, comprising vesicular proteomics and small RNA-sequencing, was conducted on tissue EVs. TargetScan identified microRNA targets. Pathway network analyses prioritized genes for validation in primary human carotid artery smooth muscle cells and aortic valvular interstitial cells. RESULTS Disease progression drove significant convergence (P<0.0001) of carotid artery plaque and calcified aortic valve proteomes (2318 proteins). Each tissue also retained a unique subset of differentially enriched proteins (381 in plaques; 226 in valves; q<0.05). Vesicular gene ontology terms increased 2.9-fold (P<0.0001) among proteins modulated by disease in both tissues. Proteomics identified 22 EV markers in tissue digest fractions. Networks of proteins and microRNA targets changed by disease progression in both artery and valve EVs revealed shared involvement in intracellular signaling and cell cycle regulation. Vesiculomics identified 773 proteins and 80 microRNAs differentially enriched by disease exclusively in artery or valve EVs (q<0.05); multiomics integration found tissue-specific EV cargoes associated with procalcific Notch and Wnt signaling in carotid arteries and aortic valves, respectively. Knockdown of tissue-specific EV-derived molecules FGFR2, PPP2CA, and ADAM17 in human carotid artery smooth muscle cells and WNT5A, APP, and APC in human aortic valvular interstitial cells significantly modulated calcification. CONCLUSIONS The first comparative proteomics study of human carotid artery plaques and calcified aortic valves identifies unique drivers of atherosclerosis versus aortic valve stenosis and implicates EVs in advanced cardiovascular calcification. We delineate a vesiculomics strategy to isolate, purify, and study protein and RNA cargoes from EVs entrapped in fibrocalcific tissues. Integration of vesicular proteomics and transcriptomics by network approaches revealed novel roles for tissue EVs in modulating cardiovascular disease.
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Affiliation(s)
- Mark C. Blaser
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Fabrizio Buffolo
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Arda Halu
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Mandy E. Turner
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Florian Schlotter
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Hideyuki Higashi
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorena Pantano
- T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Cassandra L. Clift
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Louis A. Saddic
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Samantha K. Atkins
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Maximillian A. Rogers
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tan Pham
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Amélie Vromman
- Center for Excellence in Vascular Biology, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Eugenia Shvartz
- Center for Excellence in Vascular Biology, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Galina K Sukhova
- Center for Excellence in Vascular Biology, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Giovanni Camussi
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Simon C. Robson
- Center for Inflammation Research, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Simon C. Body
- Boston University School of Medicine, Boston, MA, USA
| | - Jochen D. Muehlschlegel
- Center for Perioperative Genomics, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sasha A. Singh
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Masanori Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Center for Excellence in Vascular Biology, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Center for Excellence in Vascular Biology, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Buffolo F, Pieroni J, Ponzetto F, Forestiero V, Rossato D, Fonio P, Nonnato A, Settanni F, Mulatero P, Mengozzi G, Monticone S. Prevalence of Cortisol Cosecretion in Patients With Primary Aldosteronism: Role of Metanephrine in Adrenal Vein Sampling. J Clin Endocrinol Metab 2023; 108:e720-e725. [PMID: 36974473 DOI: 10.1210/clinem/dgad179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/19/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
CONTEXT Adrenal venous sampling (AVS) is the gold standard procedure for subtype diagnosis in patients with primary aldosteronism (PA). Cortisol is usually adopted for the normalization of aldosterone levels in peripheral and adrenal samples. However, asymmetrical cortisol secretion can potentially affect the lateralization index, leading to subtype misdiagnosis. OBJECTIVE We aimed to assess the prevalence of asymmetrical cortisol secretion in patients undergoing AVS and whether variations in adrenal vein cortisol might influence AVS interpretations. We then evaluated the use of metanephrines for the normalization of aldosterone levels for lateralization index. METHODS We retrospectively included 101 patients with PA who underwent AVS: 49 patients underwent unstimulated AVS, while 52 patients underwent both unstimulated and cosyntropin-stimulated AVS. Eighty-eight patients had bilateral successful AVS according to metanephrine ratio. We assessed the prevalence of asymmetrical cortisol secretion through the cortisol to metanephrine (C/M) lateralization index (LI). We then evaluated whether the use of aldosterone to metanephrine (A/M) LI can improve the diagnostic accuracy of AVS compared with aldosterone to cortisol (A/C) LI. RESULTS Asymmetrical cortisol secretion is present in 18% of patients with PA. Diagnosis with A/M LI and A/C LI is discordant in 14% of patients: 9% had a diagnosis of unilateral PA with A/M LI instead of bilateral PA with A/C LI and 5% had a diagnosis of bilateral PA with A/M LI instead of unilateral PA. CONCLUSION The assessment of metanephrine levels in AVS is useful for the determination of selectivity and lateralization, allowing an accurate diagnosis, especially in patients with asymmetrical cortisol secretion.
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Affiliation(s)
- Fabrizio Buffolo
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Jacopo Pieroni
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Federico Ponzetto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Vittorio Forestiero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Denis Rossato
- Division of Radiology, University of Torino, 10126 Torino, Italy
| | - Paolo Fonio
- Division of Radiology, University of Torino, 10126 Torino, Italy
| | - Antonello Nonnato
- Department of Laboratory Medicine, University of Torino, 10126 Torino, Italy
| | - Fabio Settanni
- Department of Laboratory Medicine, University of Torino, 10126 Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Giulio Mengozzi
- Department of Laboratory Medicine, University of Torino, 10126 Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
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Sconfienza E, Tetti M, Forestiero V, Veglio F, Mulatero P, Monticone S. Prevalence of Functioning Adrenal Incidentalomas: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2023; 108:1813-1823. [PMID: 36718682 DOI: 10.1210/clinem/dgad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/28/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
CONTEXT Adrenal hyperfunction is associated with an increased risk of cardiometabolic complications in subjects with adrenal incidentaloma (AI). Reliable prevalence estimates of functioning AIs are important to direct resources allocations. OBJECTIVE To assess the prevalence of autonomous/possible autonomous cortisol secretion (ACS), primary aldosteronism (PA), pheochromocytoma (PHEO), and Cushing syndrome (CS) in patients with AI. METHODS We performed a comprehensive search of multiple databases (PubMed, Ovid MEDLINE, Web of Science) for potentially relevant studies without language restriction, up to February 2022. Of the 1661 publications evaluated at title and abstract levels, 161 were examined as full text and 36 were included. Study level clinical data were extracted by 3 independent reviewers. RESULTS The overall prevalence of functioning AIs was 27.5% (95% CI 23.0, 32.5). ACS/possible ACS, with a prevalence of 11.7% (95% CI 8.6, 15.7), was the most frequent hormonal alteration, while PA occurred in 4.4% of the patients (95% CI 3.1, 6.2). Subgroup analysis showed that PA was more prevalent in patients from Asia than in patients from Europe/America; in contrast, ACS/possible ACS had a lower prevalence in Asian countries. At meta-regression analysis, the prevalence of ACS/possible ACS was influenced by the proportion of female patients, while the prevalence of PA was positively associated with the proportion of patients with hypertension and the publication year. Finally, PHEO and CS prevalence were 3.8% (95% CI 2.8, 5.0) and 3.1% (95% CI 2.3, 4.3) respectively. CONCLUSION This meta-analysis provides extensive data on the prevalence of functioning AIs and the factors affecting heterogeneity in prevalence estimates.
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Affiliation(s)
- Elisa Sconfienza
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126 Torino, Italy
| | - Martina Tetti
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126 Torino, Italy
| | - Vittorio Forestiero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126 Torino, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126 Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126 Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126 Torino, Italy
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Abstract
Primary aldosteronism (PA) is the most common form of secondary hypertension. Although hypertensive disorders seem to affect around 5-10% of pregnancies worldwide, literature counts less than 80 cases of PA diagnosed during the peri-partum period. In this review we discuss about current knowledge on pathophysiology, natural history, diagnosis and treatment of PA in pregnancy. Because of the physiologic changes in the renin-angiotensin-aldosterone system (RAAS) and the contraindication to both confirmatory test and subtype differentiation, diagnosis of PA during pregnancy is challenging and relies mostly on detection of low/suppressed renin and high aldosterone levels. The course of pregnancy in patients with PA is highly variable, ranging from progesterone-induced amelioration of blood pressure (BP) control to severe and resistant hypertension with potential maternal and fetal complications. Mineralcorticoid receptor antagonists (MRA) are the recommended and most effective drugs for treatment of PA. As the anti-androgenic effect of spironolactone can potentially interfere with sexual development, their prescription is not recommended during pregnancy. On the other side, eplerenone, has proven to be safe and effective in 6 pregnant women and may be added to conventional first line drug regimen in presence of resistant hypertension or persistent hypokalemia. Ideally, patients with unilateral forms of PA should undergo adrenalectomy prior to conception, however, when PA is diagnosed during pregnancy and medical therapy fails to adequately control hypertension or its complications, adrenalectomy can be considered during the second trimester in case of unilateral adrenal mass at MRI-scan.
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Affiliation(s)
- Vittorio Forestiero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - Elisa Sconfienza
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy.
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
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7
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Mancusi C, Bisogni V, Maloberti A, Manzi MV, Visco V, Biolcati M, Giani V, Spannella F, Monticone S, Saladini F, Rivasi G, Turrin G, Pucci G, Pengo M, Bertacchini F, Ferri C, Grassi G, Muiesan ML, Fucile I, Sorvillo G, Grieco F, Jacobitti G, Di Costanzo A, Vittoria Govetosa M, D’Avino G, D’Agosto D, Schiavi P, Biondini S, Ristori L. Accuracy of home blood pressure measurement: the ACCURAPRESS study – a proposal of Young Investigator Group of the Italian Hypertension Society (Società Italiana dell’Ipertensione Arteriosa). Blood Press 2022; 31:297-304. [DOI: 10.1080/08037051.2022.2137461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Valeria Bisogni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- ASST GOM Niguarda Hospital, Milan, Italy
| | - Maria Virginia Manzi
- Hypertension Research Center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy
| | - Marco Biolcati
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Valentina Giani
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Silvia Monticone
- Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | | | - Giulia Rivasi
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giada Turrin
- Hypertension Clinic, Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Martino Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Fabio Bertacchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy and 2a Medicina ASST Spedali Civili di Brescia, Brescia, Italy
| | - Claudio Ferri
- MeSVA Department and San Salvatore Hospital, UOC Internal Medicine and Nephrology, University of L’Aquila, L’Aquila, Italy
| | - Guido Grassi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy and 2a Medicina ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ilaria Fucile
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Gianmarco Sorvillo
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Fabrizia Grieco
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Giulia Jacobitti
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Anita Di Costanzo
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Maria Vittoria Govetosa
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Giuseppina D’Avino
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
| | - Domenico D’Agosto
- Hypertension Research center and Department of Advanced Biomedical Science, Federico II University of Naples, Napoli, Italy
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8
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Mulatero P, Bertello C, Veglio F, Monticone S. Approach to the Patient on Antihypertensive Therapy: Screen for Primary Aldosteronism. J Clin Endocrinol Metab 2022; 107:3175-3181. [PMID: 35964152 DOI: 10.1210/clinem/dgac460] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Indexed: 11/19/2022]
Abstract
Primary aldosteronism (PA) is a condition that is still largely overlooked, resulting in a considerable burden of mortality and morbidity. This is despite decades of clinical and translational research on the deleterious effects of aldosterone on the cardiovascular system and the publication of several guidelines and consensuses on its diagnosis and treatment. One of the main reasons for the low rate of testing is the difficulty of screening patients on antihypertensive therapy that potentially interferes with aldosterone and renin levels and thus confound the interpretation of the aldosterone to renin ratio, the accepted and conventionally used screening test. To avoid interference, usually the therapies that affect the renin-angiotensin aldosterone system are withdrawn and substituted with noninterfering medications. However, in many cases the screening test can be confidently interpreted even when such therapies are not discontinued. In this review, we will evaluate the effects of antihypertensive therapies on the screening test for PA and suggest a practical approach for its interpretation.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126, Torino, Italy
| | - Chiara Bertello
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126, Torino, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126, Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126, Torino, Italy
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9
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Armignacco R, Reel PS, Reel S, Jouinot A, Septier A, Gaspar C, Perlemoine K, Larsen CK, Bouys L, Braun L, Riester A, Kroiss M, Bonnet-Serrano F, Amar L, Blanchard A, Gimenez-Roqueplo AP, Prejbisz A, Januszewicz A, Dobrowolski P, Davies E, MacKenzie SM, Rossi GP, Lenzini L, Ceccato F, Scaroni C, Mulatero P, Williams TA, Pecori A, Monticone S, Beuschlein F, Reincke M, Zennaro MC, Bertherat J, Jefferson E, Assié G. Whole blood methylome-derived features to discriminate endocrine hypertension. Clin Epigenetics 2022; 14:142. [PMCID: PMC9635165 DOI: 10.1186/s13148-022-01347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Arterial hypertension represents a worldwide health burden and a major risk factor for cardiovascular morbidity and mortality. Hypertension can be primary (primary hypertension, PHT), or secondary to endocrine disorders (endocrine hypertension, EHT), such as Cushing's syndrome (CS), primary aldosteronism (PA), and pheochromocytoma/paraganglioma (PPGL). Diagnosis of EHT is currently based on hormone assays. Efficient detection remains challenging, but is crucial to properly orientate patients for diagnostic confirmation and specific treatment. More accurate biomarkers would help in the diagnostic pathway. We hypothesized that each type of endocrine hypertension could be associated with a specific blood DNA methylation signature, which could be used for disease discrimination. To identify such markers, we aimed at exploring the methylome profiles in a cohort of 255 patients with hypertension, either PHT (n = 42) or EHT (n = 213), and at identifying specific discriminating signatures using machine learning approaches. Results Unsupervised classification of samples showed discrimination of PHT from EHT. CS patients clustered separately from all other patients, whereas PA and PPGL showed an overall overlap. Global methylation was decreased in the CS group compared to PHT. Supervised comparison with PHT identified differentially methylated CpG sites for each type of endocrine hypertension, showing a diffuse genomic location. Among the most differentially methylated genes, FKBP5 was identified in the CS group. Using four different machine learning methods—Lasso (Least Absolute Shrinkage and Selection Operator), Logistic Regression, Random Forest, and Support Vector Machine—predictive models for each type of endocrine hypertension were built on training cohorts (80% of samples for each hypertension type) and estimated on validation cohorts (20% of samples for each hypertension type). Balanced accuracies ranged from 0.55 to 0.74 for predicting EHT, 0.85 to 0.95 for predicting CS, 0.66 to 0.88 for predicting PA, and 0.70 to 0.83 for predicting PPGL. Conclusions The blood DNA methylome can discriminate endocrine hypertension, with methylation signatures for each type of endocrine disorder. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-022-01347-y.
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Affiliation(s)
- Roberta Armignacco
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France
| | - Parminder S. Reel
- grid.8241.f0000 0004 0397 2876Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, DD2 4BF UK
| | - Smarti Reel
- grid.8241.f0000 0004 0397 2876Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, DD2 4BF UK
| | - Anne Jouinot
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France ,grid.440907.e0000 0004 1784 3645Institut Curie, INSERM U900, MINES ParisTech, PSL-Research University, CBIO-Centre for Computational Biology, Paris, France
| | - Amandine Septier
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France
| | - Cassandra Gaspar
- Sorbonne Université, INSERM, UMS Production et Analyse de données en Sciences de la vie et en Santé, PASS, Plateforme Post-génomique de la Pitié-Salpêtrière, P3S, 75013 Paris, France
| | - Karine Perlemoine
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France
| | - Casper K. Larsen
- grid.462416.30000 0004 0495 1460Université Paris Cité, Inserm, PARCC, F-75015 Paris, France
| | - Lucas Bouys
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France
| | - Leah Braun
- grid.411095.80000 0004 0477 2585Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anna Riester
- grid.411095.80000 0004 0477 2585Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Matthias Kroiss
- grid.411095.80000 0004 0477 2585Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Fidéline Bonnet-Serrano
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France ,grid.411784.f0000 0001 0274 3893Service d’Hormonologie, AP-HP, Hôpital Cochin, F-75014 Paris, France
| | - Laurence Amar
- grid.462416.30000 0004 0495 1460Université Paris Cité, Inserm, PARCC, F-75015 Paris, France ,grid.414093.b0000 0001 2183 5849Unité Hypertension Artérielle, AP-HP, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Anne Blanchard
- grid.414093.b0000 0001 2183 5849Centre d’Investigations Cliniques 9201, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Anne-Paule Gimenez-Roqueplo
- grid.462416.30000 0004 0495 1460Université Paris Cité, Inserm, PARCC, F-75015 Paris, France ,grid.414093.b0000 0001 2183 5849Département de Médecine Génomique des Tumeurs et des Cancers, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Aleksander Prejbisz
- grid.418887.aDepartment of Hypertension, Institute of Cardiology, Warsaw, Poland
| | - Andrzej Januszewicz
- grid.418887.aDepartment of Hypertension, Institute of Cardiology, Warsaw, Poland
| | - Piotr Dobrowolski
- grid.418887.aDepartment of Hypertension, Institute of Cardiology, Warsaw, Poland
| | - Eleanor Davies
- grid.8756.c0000 0001 2193 314XBHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA UK
| | - Scott M. MacKenzie
- grid.8756.c0000 0001 2193 314XBHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, G12 8TA UK
| | - Gian Paolo Rossi
- Department of Medicine-DIMED, Emergency and Hypertension Unit, University of Padova, University Hospital, Padua, Italy
| | - Livia Lenzini
- Department of Medicine-DIMED, Emergency and Hypertension Unit, University of Padova, University Hospital, Padua, Italy
| | - Filippo Ceccato
- grid.411474.30000 0004 1760 2630UOC Endocrinologia, Dipartimento di Medicina DIMED, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - Carla Scaroni
- grid.411474.30000 0004 1760 2630UOC Endocrinologia, Dipartimento di Medicina DIMED, Azienda Ospedaliera-Università di Padova, Padua, Italy
| | - Paolo Mulatero
- grid.7605.40000 0001 2336 6580Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Turin, Italy
| | - Tracy A. Williams
- grid.7605.40000 0001 2336 6580Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Turin, Italy
| | - Alessio Pecori
- grid.7605.40000 0001 2336 6580Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Turin, Italy
| | - Silvia Monticone
- grid.7605.40000 0001 2336 6580Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Turin, Italy
| | - Felix Beuschlein
- grid.411095.80000 0004 0477 2585Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany ,grid.412004.30000 0004 0478 9977Klinikfür Endokrinologie, Diabetologie Und Klinische Ernährung, UniversitätsSpital Zürich (USZ) and Universität Zürich (UZH), Raemistrasse 100, 8091 Zurich, Switzerland
| | - Martin Reincke
- grid.411095.80000 0004 0477 2585Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maria-Christina Zennaro
- grid.462416.30000 0004 0495 1460Université Paris Cité, Inserm, PARCC, F-75015 Paris, France ,grid.414093.b0000 0001 2183 5849Service de Génétique, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Jérôme Bertherat
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France ,grid.411784.f0000 0001 0274 3893Service d’Endocrinologie, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, F-75014 Paris, France
| | - Emily Jefferson
- grid.8241.f0000 0004 0397 2876Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, DD2 4BF UK ,grid.8756.c0000 0001 2193 314XInstitute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ UK
| | - Guillaume Assié
- grid.462098.10000 0004 0643 431XUniversité Paris Cité, CNRS, INSERM, Institut Cochin, F-75014 Paris, France ,grid.411784.f0000 0001 0274 3893Service d’Endocrinologie, Center for Rare Adrenal Diseases, AP-HP, Hôpital Cochin, F-75014 Paris, France
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10
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Januszewicz A, Mulatero P, Dobrowolski P, Monticone S, Van der Niepen P, Sarafidis P, Reincke M, Rexhaj E, Eisenhofer G, Januszewicz M, Kasiakogias A, Kreutz R, Lenders JW, Muiesan ML, Persu A, Agabiti-Rosei E, Soria R, Śpiewak M, Prejbisz A, Messerli FH. Cardiac Phenotypes in Secondary Hypertension. J Am Coll Cardiol 2022; 80:1480-1497. [DOI: 10.1016/j.jacc.2022.08.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
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11
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Reel PS, Reel S, van Kralingen JC, Langton K, Lang K, Erlic Z, Larsen CK, Amar L, Pamporaki C, Mulatero P, Blanchard A, Kabat M, Robertson S, MacKenzie SM, Taylor AE, Peitzsch M, Ceccato F, Scaroni C, Reincke M, Kroiss M, Dennedy MC, Pecori A, Monticone S, Deinum J, Rossi GP, Lenzini L, McClure JD, Nind T, Riddell A, Stell A, Cole C, Sudano I, Prehn C, Adamski J, Gimenez-Roqueplo AP, Assié G, Arlt W, Beuschlein F, Eisenhofer G, Davies E, Zennaro MC, Jefferson E. Machine learning for classification of hypertension subtypes using multi-omics: A multi-centre, retrospective, data-driven study. EBioMedicine 2022; 84:104276. [PMID: 36179553 PMCID: PMC9520210 DOI: 10.1016/j.ebiom.2022.104276] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/09/2022] Open
Abstract
Background Arterial hypertension is a major cardiovascular risk factor. Identification of secondary hypertension in its various forms is key to preventing and targeting treatment of cardiovascular complications. Simplified diagnostic tests are urgently required to distinguish primary and secondary hypertension to address the current underdiagnosis of the latter. Methods This study uses Machine Learning (ML) to classify subtypes of endocrine hypertension (EHT) in a large cohort of hypertensive patients using multidimensional omics analysis of plasma and urine samples. We measured 409 multi-omics (MOmics) features including plasma miRNAs (PmiRNA: 173), plasma catechol O-methylated metabolites (PMetas: 4), plasma steroids (PSteroids: 16), urinary steroid metabolites (USteroids: 27), and plasma small metabolites (PSmallMB: 189) in primary hypertension (PHT) patients, EHT patients with either primary aldosteronism (PA), pheochromocytoma/functional paraganglioma (PPGL) or Cushing syndrome (CS) and normotensive volunteers (NV). Biomarker discovery involved selection of disease combination, outlier handling, feature reduction, 8 ML classifiers, class balancing and consideration of different age- and sex-based scenarios. Classifications were evaluated using balanced accuracy, sensitivity, specificity, AUC, F1, and Kappa score. Findings Complete clinical and biological datasets were generated from 307 subjects (PA=113, PPGL=88, CS=41 and PHT=112). The random forest classifier provided ∼92% balanced accuracy (∼11% improvement on the best mono-omics classifier), with 96% specificity and 0.95 AUC to distinguish one of the four conditions in multi-class ALL-ALL comparisons (PPGL vs PA vs CS vs PHT) on an unseen test set, using 57 MOmics features. For discrimination of EHT (PA + PPGL + CS) vs PHT, the simple logistic classifier achieved 0.96 AUC with 90% sensitivity, and ∼86% specificity, using 37 MOmics features. One PmiRNA (hsa-miR-15a-5p) and two PSmallMB (C9 and PC ae C38:1) features were found to be most discriminating for all disease combinations. Overall, the MOmics-based classifiers were able to provide better classification performance in comparison to mono-omics classifiers. Interpretation We have developed a ML pipeline to distinguish different EHT subtypes from PHT using multi-omics data. This innovative approach to stratification is an advancement towards the development of a diagnostic tool for EHT patients, significantly increasing testing throughput and accelerating administration of appropriate treatment. Funding European Union's Horizon 2020 Research and Innovation Programme under Grant Agreement No. 633983, Clinical Research Priority Program of the University of Zurich for the CRPP HYRENE (to Z.E. and F.B.), and Deutsche Forschungsgemeinschaft (CRC/Transregio 205/1).
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12
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Burrello J, Monticone S, Burrello A, Bolis S, Cristalli CP, Comai G, Corradetti V, Grange C, Orlando G, Bonafè M, La Manna G, Barile L, Bussolati B. Identification of a serum and urine extracellular vesicle signature predicting renal outcome after kidney transplant. Nephrol Dial Transplant 2022; 38:764-777. [PMID: 36073758 PMCID: PMC9976747 DOI: 10.1093/ndt/gfac259] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A long-standing effort is dedicated towards the identification of biomarkers allowing the prediction of graft outcome after kidney transplant. Extracellular vesicles (EVs) circulating in body fluids represent an attractive candidate, as their cargo mirrors the originating cell and its pathophysiological status. The aim of the study was to investigate EV surface antigens as potential predictors of renal outcome after kidney transplant. METHODS We characterized 37 surface antigens by flow cytometry, in serum and urine EVs from 58 patients who were evaluated before, and at 10-14 days, 3 months and 1 year after transplant, for a total of 426 analyzed samples. The outcome was defined according to estimated glomerular filtration rate (eGFR) at 1 year. RESULTS Endothelial cells and platelets markers (CD31, CD41b, CD42a and CD62P) in serum EVs were higher at baseline in patients with persistent kidney dysfunction at 1 year, and progressively decreased after kidney transplant. Conversely, mesenchymal progenitor cell marker (CD1c, CD105, CD133, SSEEA-4) in urine EVs progressively increased after transplant in patients displaying renal recovery at follow-up. These markers correlated with eGFR, creatinine and proteinuria, associated with patient outcome at univariate analysis and were able to predict patient outcome at receiver operating characteristics curves analysis. A specific EV molecular signature obtained by supervised learning correctly classified patients according to 1-year renal outcome. CONCLUSIONS An EV-based signature, reflecting the cardiovascular profile of the recipient, and the repairing/regenerative features of the graft, could be introduced as a non-invasive tool for a tailored management of follow-up of patients undergoing kidney transplant.
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Affiliation(s)
- Jacopo Burrello
- Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland,Department of Medical Sciences, University of Torino, Italy
| | | | - Alessio Burrello
- Department of Electrical, Electronic and Information Engineering (DEI), University of Bologna, Italy
| | - Sara Bolis
- Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Carlotta Pia Cristalli
- IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Nephrology, Dialysis and Renal Transplant Unit, University of Bologna, Italy
| | - Giorgia Comai
- IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Nephrology, Dialysis and Renal Transplant Unit, University of Bologna, Italy
| | - Valeria Corradetti
- IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Nephrology, Dialysis and Renal Transplant Unit, University of Bologna, Italy
| | | | - Giuseppe Orlando
- Department of Surgery, Section of Transplantation, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Massimiliano Bonafè
- IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Nephrology, Dialysis and Renal Transplant Unit, University of Bologna, Italy,Department of Experimental, Diagnostic and Specialty Medicine, AlmaMater Studiorum, Universitá di Bologna
| | - Gaetano La Manna
- IRCCS – Azienda Ospedaliero-Universitaria di Bologna, Nephrology, Dialysis and Renal Transplant Unit, University of Bologna, Italy
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13
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Abstract
Besides the physiological regulation of water, sodium, and potassium homeostasis, aldosterone modulates several physiological and pathological processes in the cardiovascular system. At the vascular level, aldosterone excess stimulates endothelial dysfunction and infiltration of inflammatory cells, enhances the development of the atherosclerotic plaque, and favors plaque instability, arterial stiffness, and calcification. At the cardiac level, aldosterone increases cardiac inflammation, fibrosis, and myocardial hypertrophy. As a clinical consequence, high aldosterone levels are associated with enhanced risk of cardiovascular events and mortality, especially when aldosterone secretion is inappropriate for renin levels and sodium intake, as in primary aldosteronism. Several clinical trials showed that mineralocorticoid receptor antagonists reduce cardiovascular mortality in patients with heart failure and reduced ejection fraction, but inconclusive results were reported for other cardiovascular conditions, such as heart failure with preserved ejection fraction, myocardial infarction, and atrial fibrillation. In patients with primary aldosteronism, adrenalectomy or treatment with mineralocorticoid receptor antagonists significantly mitigate adverse aldosterone effects, reducing the risk of cardiovascular events, mortality, and incident atrial fibrillation. In this review, we will summarize the major preclinical and clinical studies investigating the cardiovascular damage mediated by aldosterone and the protective effect of mineralocorticoid receptor antagonists for the reduction of cardiovascular risk in patients with cardiovascular diseases and primary aldosteronism.
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Affiliation(s)
- Fabrizio Buffolo
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy
| | - Martina Tetti
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy
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14
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Burrello J, Burrello A, Vacchi E, Bianco G, Caporali E, Amongero M, Airale L, Bolis S, Vassalli G, Cereda CW, Mulatero P, Bussolati B, Camici GG, Melli G, Monticone S, Barile L. Supervised and unsupervised learning to define the cardiovascular risk of patients according to an extracellular vesicle molecular signature. Transl Res 2022; 244:114-125. [PMID: 35202881 DOI: 10.1016/j.trsl.2022.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/28/2022] [Accepted: 02/16/2022] [Indexed: 12/21/2022]
Abstract
Cardiovascular (CV) disease represents the most common cause of death in developed countries. Risk assessment is highly relevant to intervene at individual level and implement prevention strategies. Circulating extracellular vesicles (EVs) are involved in the development and progression of CV diseases and are considered promising biomarkers. We aimed at identifying an EV signature to improve the stratification of patients according to CV risk and likelihood to develop fatal CV events. EVs were characterized by nanoparticle tracking analysis and flow cytometry for a standardized panel of 37 surface antigens in a cross-sectional multicenter cohort (n = 486). CV profile was defined by presence of different indicators (age, sex, body mass index, hypertension, hyperlipidemia, diabetes, coronary artery disease, cardiac heart failure, chronic kidney disease, smoking habit, organ damage) and according to the 10-year risk of fatal CV events estimated using SCORE charts of European Society of Cardiology. By combining expression levels of EV antigens using unsupervised learning, patients were classified into 3 clusters: Cluster-I (n = 288), Cluster-II (n = 83), Cluster-III (n = 30). A separate analysis was conducted on patients displaying acute CV events (n = 82). Prevalence of hypertension, diabetes, chronic heart failure, and organ damage (defined as left ventricular hypertrophy and/or microalbuminuria) increased progressively from Cluster-I to Cluster-III. Several EV antigens, including markers for platelets (CD41b-CD42a-CD62P), leukocytes (CD1c-CD2-CD3-CD4-CD8-CD14-CD19-CD20-CD25-CD40-CD45-CD69-CD86), and endothelium (CD31-CD105) were independently associated with CV risk indicators and correlated to age, blood pressure, glucometabolic profile, renal function, and SCORE risk. EV profiling, obtained from minimally invasive blood sampling, allows accurate patient stratification according to CV risk profile.
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Affiliation(s)
- Jacopo Burrello
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy
| | - Alessio Burrello
- Department of Electrical, Electronic and Information Engineering (DEI), University of Bologna, Italy
| | - Elena Vacchi
- Laboratory for Biomedical Neurosciences, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Giovanni Bianco
- Neurology Clinic, Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Elena Caporali
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Martina Amongero
- Department of Mathematical Sciences G. L. Lagrange, Polytechnic University of Torino, Italy
| | - Lorenzo Airale
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy
| | - Sara Bolis
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Giuseppe Vassalli
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Carlo W Cereda
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Neurology Clinic, Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy
| | - Benedetta Bussolati
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Italy
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland
| | - Giorgia Melli
- Laboratory for Biomedical Neurosciences, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy
| | - Lucio Barile
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Laboratories for Translational Research, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Institute of Life Science, Scuola Superiore Sant'Anna, Pisa, Italy.
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15
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Gallone G, Burrello J, Burrello A, Iannaccone M, De Luca L, Patti G, Cerrato E, Venuti G, De Filippo O, Mattesini A, Muscoli S, Trabattoni D, Giammaria M, Truffa A, Cortese B, Conrotto F, Mulatero P, Monticone S, Escaned J, Usmiani T, D‘ascenzo F, De Ferrari G, Breviario S. C25 PREDICTION OF ALL–CAUSE MORTALITY FOLLOWING PERCUTANEOUS CORONARY INTERVENTION IN BIFURCATION LESIONS USING MACHINE LEARNING ALGORITHMS – THE RAIN–ML PREDICTION MODEL. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Stratifying prognosis following coronary bifurcation percutaneous coronary intervention (PCI) is an unmet need. Machine learning (ML) may identify patterns from multidimensional, non–linear relationships to make outcome predictions. We sought to develop a ML–based risk stratification model built on clinical, anatomical and procedural features to predict all–cause mortality following contemporary bifurcation PCI.
Methods and Results
Multiple ML models to predict all–cause mortality were tested on a cohort of 2,393 patients (training, n = 1,795; internal validation, n = 598) undergoing bifurcation PCI with contemporary stents from the real–world RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry. Among 38 commonly available features, 25 (13 patient–related, 12 lesion–related) were selected to train ML models. The best performing model (the RAIN–ML prediction model) was validated in an external validation cohort of 1,701 patients undergoing bifurcation PCI from the DUTCH PEERS (DUrable polymer–based sTent CHallenge of Promus ElemEnt versus ReSolute integrity: TWENTE II) trial and the BIO–RESORT trial cohorts. The area under the receiver operating characteristic curves for the prediction of 2–year mortality was 0.786 (0.74–0.83) in the overall population, 0.736 (0.72–0.847) at internal validation and 0.706 (0.6919–0.794) at external validation. Performance at risk ranking analysis, k–center cross validation, and with continual learning confirmed the generalizability of the models, available also as an online interface.
Conclusions
The RAIN–ML prediction model represents the first tool combining clinical, anatomical and procedural features to predict all–cause mortality among patients undergoing contemporary bifurcation PCI with a good discriminative performance.
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Affiliation(s)
- G Gallone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - J Burrello
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Burrello
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - M Iannaccone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - L De Luca
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G Patti
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - E Cerrato
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G Venuti
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - O De Filippo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Mattesini
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Muscoli
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - D Trabattoni
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - M Giammaria
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - A Truffa
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - B Cortese
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - F Conrotto
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - P Mulatero
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Monticone
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - J Escaned
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - T Usmiani
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - F D‘ascenzo
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - G De Ferrari
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
| | - S Breviario
- CITTÀ DELLA SALUTE E DELLA SCIENZA, TORINO; UNIVERSITÀ DI BOLOGNA, BOLOGNA; OSPEDALE S. GIOVANNI EVANGELISTA, TIVOLI, ROMA; AZIENDA OSPEDALIERO UNIVERSITARIA MAGGIORE DELLA CARITÀ, NOVARA; OSPEDALE DEGLI INFERMI, RIVOLI E OSPEDALE SAN LUIGI GONZAGA, ORBASSANO, RIVOLI; AZIENDA OSPEDALIERO UNIVERSITARIA POLICLINICO–VITTORIO EMANUELE, CATANIA; OSPEDALE UNIVERSITARIO CAREGGI, FIRENZE; UNIVERSITÀ DEGL
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Palazzuoli A, Tecson KM, Vicenzi M, D'Ascenzo F, De Ferrari GM, Monticone S, Secco GG, Tavazzi G, Forleo G, Severino P, Fedele F, De Rosa F, McCullough PA. Usefulness of Combined Renin-Angiotensin System Inhibitors and Diuretic Treatment In Patients Hospitalized with COVID-19. Am J Cardiol 2022; 167:133-138. [PMID: 35027137 PMCID: PMC8744009 DOI: 10.1016/j.amjcard.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 12/22/2022]
Abstract
Antecedent use of renin-angiotensin system inhibitors (RASi) prevents clinical deterioration and protects against cardiovascular/thrombotic complications of COVID-19, for indicated patients. Uncertainty exists regarding treatment continuation throughout infection and doing so with concomitant medications. Hence, the purpose of this study is to evaluate the differential effect of RASi continuation in patients hospitalized with COVID-19 according to diuretic use. We used the Coracle registry, which contains data of hospitalized patients with COVID-19 from 4 regions of Italy. We used Firth logistic regression for adult (>50 years) cases with admission on/after February 22, 2020, with a known discharge status as of April 1, 2020. There were 286 patients in this analysis; 100 patients (35.0%) continued RASi and 186 (65%) discontinued. There were 98 patients treated with a diuretic; 51 (52%) of those continued RASi. The in-hospital mortality rates in patients treated with a diuretic and continued versus discontinued RASi were 8% versus 26% (p = 0.0179). There were 188 patients not treated with a diuretic; 49 (26%) of those continued RASi. The in-hospital mortality rates in patients not treated with a diuretic and continued versus discontinued RASi were 16% versus 9% (p = 0.1827). After accounting for age, cardiovascular disease, and laboratory values, continuing RASi decreased the risk of mortality by approximately 77% (odds ratio 0.23, 95% confidence interval 0.06 to 0.95, p = 0.0419) for patients treated with diuretics, but did not alter the risk in patients treated with RASi alone. Continuing RASi in patients concomitantly treated with diuretics was associated with reduced in-hospital mortality.
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Abstract
Extracellular vesicles (EVs) are nanosized membrane-bound structures released by cells that are able to transfer nucleic acids, protein cargos, and metabolites to specific recipient cells, allowing cell-to-cell communications in an endocrine and paracrine manner. Endothelial, leukocyte, and platelet-derived EVs have emerged both as biomarkers and key effectors in the development and progression of different stages of vascular damage, from earliest alteration of endothelial function, to advanced atherosclerotic lesions and cardiovascular calcification. Under pathological conditions, circulating EVs promote endothelial dysfunction by impairing vasorelaxation and instigate vascular inflammation by increasing levels of adhesion molecules, reactive oxygen species, and proinflammatory cytokines. Platelets, endothelial cells, macrophages, and foam cells secrete EVs that regulate macrophage polarization and contribute to atherosclerotic plaque progression. Finally, under pathological stimuli, smooth muscle cells and macrophages secrete EVs that aggregate between collagen fibers and serve as nucleation sites for ectopic mineralization in the vessel wall, leading to formation of micro- and macrocalcification. In this review, we summarize the emerging evidence of the pathological role of EVs in vascular damage, highlighting the major findings from the most recent studies and discussing future perspectives in this research field.
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Affiliation(s)
- Fabrizio Buffolo
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy. (F.B., S.M.).,Center for Interdisciplinary Cardiovascular Sciences, Department of Cardiovascular Medicine (F.B, E.A.)
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy. (F.B., S.M.)
| | - Giovanni Camussi
- Department of Medical Sciences, Molecular Biotechnology Center, University of Torino, Italy. (G.C.)
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Department of Cardiovascular Medicine (F.B, E.A.).,Center for Excellence in Vascular Biology, Department of Cardiovascular Medicine (E.A.)
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18
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Monticone S, Veglio F, Mulatero P. Response to Letter to the Editor from Rossi and Rossitto: "Mineralocorticoid Receptor Antagonist Effect on Aldosterone to Renin Ratio in Patients With Primary Aldosteronism". J Clin Endocrinol Metab 2022; 107:e896-e897. [PMID: 34610098 DOI: 10.1210/clinem/dgab719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Silvia Monticone
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Franco Veglio
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
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Buffolo F, Burrello J, Burrello A, Heinrich D, Adolf C, Müller LM, Chen R, Forestiero V, Sconfienza E, Tetti M, Veglio F, Williams TA, Mulatero P, Monticone S. Clinical Score and Machine Learning-Based Model to Predict Diagnosis of Primary Aldosteronism in Arterial Hypertension. Hypertension 2021; 78:1595-1604. [PMID: 34488439 DOI: 10.1161/hypertensionaha.121.17444] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Fabrizio Buffolo
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., J.B., R.C., V.F., E.S., M.T., F.V., T.A.W., P.M., S.M.)
| | - Jacopo Burrello
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., J.B., R.C., V.F., E.S., M.T., F.V., T.A.W., P.M., S.M.)
| | - Alessio Burrello
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Italy (A.B.)
| | - Daniel Heinrich
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany (D.H., C.A., L.M.M., T.A.W.)
| | - Christian Adolf
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany (D.H., C.A., L.M.M., T.A.W.)
| | - Lisa Marie Müller
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany (D.H., C.A., L.M.M., T.A.W.)
| | - Rusi Chen
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., J.B., R.C., V.F., E.S., M.T., F.V., T.A.W., P.M., S.M.)
| | - Vittorio Forestiero
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., J.B., R.C., V.F., E.S., M.T., F.V., T.A.W., P.M., S.M.)
| | - Elisa Sconfienza
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., J.B., R.C., V.F., E.S., M.T., F.V., T.A.W., P.M., S.M.)
| | - Martina Tetti
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., J.B., R.C., V.F., E.S., M.T., F.V., T.A.W., P.M., S.M.)
| | - Franco Veglio
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., J.B., R.C., V.F., E.S., M.T., F.V., T.A.W., P.M., S.M.)
| | - Tracy Ann Williams
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., J.B., R.C., V.F., E.S., M.T., F.V., T.A.W., P.M., S.M.).,Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany (D.H., C.A., L.M.M., T.A.W.)
| | - Paolo Mulatero
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., J.B., R.C., V.F., E.S., M.T., F.V., T.A.W., P.M., S.M.)
| | - Silvia Monticone
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., J.B., R.C., V.F., E.S., M.T., F.V., T.A.W., P.M., S.M.)
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Pecori A, Buffolo F, Burrello J, Mengozzi G, Rumbolo F, Avataneo V, D'Avolio A, Rabbia F, Bertello C, Veglio F, Mulatero P, Monticone S. Mineralocorticoid Receptor Antagonist Effect on Aldosterone to Renin Ratio in Patients With Primary Aldosteronism. J Clin Endocrinol Metab 2021; 106:e3655-e3664. [PMID: 33942084 DOI: 10.1210/clinem/dgab290] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Although current international guidelines recommend to avoid mineralocortcoid receptor antagonists in patients undergoing screening test for primary aldosteronism, a recent report suggested that mineralocorticoid receptor antagonist treatment can be continued without significant influence on screening results. OBJECTIVE We aimed to evaluate the effect of mineralocorticoid receptor antagonists on the aldosterone to renin ratio in patients with primary aldosteronism. METHODS We prospectively enrolled 121 patients with confirmed primary aldosteronism who started mineralocorticoid receptor antagonist (canrenone) treatment. Eighteen patients (11 with unilateral and 7 with bilateral primary aldosteronism) constituted the short-term study cohort and underwent aldosterone, renin, and potassium measurement after 2 and 8 weeks of canrenone therapy. The long-term cohort comprised 102 patients (16 with unilateral and 67 with bilateral primary aldosteronism, and 19 with undetermined subtype) who underwent hormonal and biochemical re-assessment after 2 to 12 months of canrenone therapy. RESULTS Renin and potassium levels showed a significant increase, and the aldosterone to renin ratio displayed a significant reduction compared with baseline after both a short- and long-term treatment. These effects were progressively more evident with higher doses of canrenone and after longer periods of treatment. We demonstrated that canrenone exerted a deep impact on the diagnostic accuracy of the screening test for primary aldosteronism: the rate of false negative tests was raised to 16.7%, 38.9%, 54.5%, and 72.5% after 2 weeks, 8 weeks, 2 to 6 months, and 7 to 12 months of mineralocorticoid receptor antagonist treatment, respectively. CONCLUSION Mineralocorticoid receptor antagonists should be avoided in patients with hypertension before measurement of renin and aldosterone for screening of primary aldosteronism.
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Affiliation(s)
- Alessio Pecori
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Fabrizio Buffolo
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Jacopo Burrello
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Giulio Mengozzi
- Department of Laboratory Medicine, AOU Città della Salute e della Scienza, Turin, Italy
| | - Francesca Rumbolo
- Department of Laboratory Medicine, AOU Città della Salute e della Scienza, Turin, Italy
| | - Valeria Avataneo
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Torino, Amedeo di Savoia Hospital, Torino, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Torino, Amedeo di Savoia Hospital, Torino, Italy
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Chiara Bertello
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
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21
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Burrello J, Tetti M, Forestiero V, Biemmi V, Bolis S, Pomatto MAC, Amongero M, Di Silvestre D, Mauri P, Vassalli G, Camussi G, Williams TA, Mulatero P, Barile L, Monticone S. Characterization of Circulating Extracellular Vesicle Surface Antigens in Patients With Primary Aldosteronism. Hypertension 2021; 78:726-737. [PMID: 34304584 DOI: 10.1161/hypertensionaha.121.17136] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jacopo Burrello
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.).,Laboratory for Cardiovascular Theranostics and Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (J.B., V.B., S.B., G.V., L.B.)
| | - Martina Tetti
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.)
| | - Vittorio Forestiero
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.)
| | - Vanessa Biemmi
- Laboratory for Cardiovascular Theranostics and Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (J.B., V.B., S.B., G.V., L.B.).,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (V.B., L.B.)
| | - Sara Bolis
- Laboratory for Cardiovascular Theranostics and Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (J.B., V.B., S.B., G.V., L.B.)
| | | | - Martina Amongero
- Department of Mathematical Sciences G. L. Lagrange, Polytechnic University of Torino, Italy (M.A.)
| | - Dario Di Silvestre
- Proteomic and Metabolomic Laboratory, Institute for Biomedical Technologies-National Research Council (ITB-CNR), Segrate (Milan), Italy (D.D.S., P. Mauri)
| | - Pierluigi Mauri
- Proteomic and Metabolomic Laboratory, Institute for Biomedical Technologies-National Research Council (ITB-CNR), Segrate (Milan), Italy (D.D.S., P. Mauri)
| | - Giuseppe Vassalli
- Laboratory for Cardiovascular Theranostics and Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (J.B., V.B., S.B., G.V., L.B.)
| | - Giovanni Camussi
- Molecular Biotechnology Center, Department of Medical Sciences, University of Torino, Italy (M.A.C.P., G.C.)
| | - Tracy Ann Williams
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.).,Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany (T.A.W)
| | - Paolo Mulatero
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.)
| | - Lucio Barile
- Laboratory for Cardiovascular Theranostics and Laboratory of Cellular and Molecular Cardiology, Cardiocentro Ticino Institute, Lugano, Switzerland (J.B., V.B., S.B., G.V., L.B.).,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (V.B., L.B.)
| | - Silvia Monticone
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy (J.B., M.T., V.F., T.A.W., P. Mulatero, S.M.)
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22
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Buffolo F, Sconfienza E, Burrello J, Losano I, Mengozzi G, Priolo G, Avataneo V, D'Avolio A, Veglio F, Rabbia F, Mulatero P, Monticone S. Assessment of Anti-Hypertensive Drug Adherence by Serial Aldosterone-To-Renin Ratio Measurement. Front Pharmacol 2021; 12:668843. [PMID: 34040531 PMCID: PMC8141919 DOI: 10.3389/fphar.2021.668843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Reduced or absent compliance to anti-hypertensive treatment is a major obstacle to the achievement of blood pressure target in patients with arterial hypertension. Current available methods for therapeutic adherence assessment display low accuracy, limited applicability in clinical practice and/or high costs. We designed a prospective study to evaluate the accuracy of serial measurement of ARR to assess the therapeutic compliance to RAAS inhibitors. We prospectively enrolled 80 subjects: 40 patients with arterial hypertension and 40 normotensive controls. The ARR was evaluated at baseline and 2 and 8 week after initiation of a RAAS inhibitor in patients with hypertension, and at baseline and 2 weeks for the control group. Adherence to the prescribed therapy was confirmed by therapeutic drug monitoring. We observed a significant increase of renin levels and reduction of aldosterone levels after RAAS inhibitors initiation, with consequent reduction of ARR. Delta ARR (ΔARR), defined as relative change in ARR before and after treatment initiation, provided high accuracy for determination of therapeutic compliance, with an AUC of 0.900 at 2 weeks and 0.886 at 8 weeks. A cut-off of −48% of ΔARR provided 90% sensitivity and 75% specificity, at 2 and 8 weeks. In conclusion, the measurement of ΔARR is a powerful test, cheap and widely available to accurately identify the non-adherence to RAAS inhibitors treatment. Herein we propose the implementation of ΔARR in clinical practice through a multi-step flow-chart for the management of patients with uncontrolled blood pressure, with identification of those suspected of non-adherence, reserving therapeutic drug monitoring for non-adherence confirmation.
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Affiliation(s)
- Fabrizio Buffolo
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Elisa Sconfienza
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Jacopo Burrello
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Isabel Losano
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Giulio Mengozzi
- Department of Laboratory Medicine, AOU Città della Salute e della Scienza, Turin, Italy
| | - Gabriella Priolo
- Department of Laboratory Medicine, AOU Città della Salute e della Scienza, Turin, Italy
| | - Valeria Avataneo
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Turin, Italy
| | - Antonio D'Avolio
- Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Turin, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Franco Rabbia
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
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Burrello J, Amongero M, Buffolo F, Sconfienza E, Forestiero V, Burrello A, Adolf C, Handgriff L, Reincke M, Veglio F, Williams TA, Monticone S, Mulatero P. Development of a Prediction Score to Avoid Confirmatory Testing in Patients With Suspected Primary Aldosteronism. J Clin Endocrinol Metab 2021; 106:e1708-e1716. [PMID: 33377974 DOI: 10.1210/clinem/dgaa974] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT The diagnostic work-up of primary aldosteronism (PA) includes screening and confirmation steps. Case confirmation is time-consuming, expensive, and there is no consensus on tests and thresholds to be used. Diagnostic algorithms to avoid confirmatory testing may be useful for the management of patients with PA. OBJECTIVE Development and validation of diagnostic models to confirm or exclude PA diagnosis in patients with a positive screening test. DESIGN, PATIENTS, AND SETTING We evaluated 1024 patients who underwent confirmatory testing for PA. The diagnostic models were developed in a training cohort (n = 522), and then tested on an internal validation cohort (n = 174) and on an independent external prospective cohort (n = 328). MAIN OUTCOME MEASURE Different diagnostic models and a 16-point score were developed by machine learning and regression analysis to discriminate patients with a confirmed diagnosis of PA. RESULTS Male sex, antihypertensive medication, plasma renin activity, aldosterone, potassium levels, and the presence of organ damage were associated with a confirmed diagnosis of PA. Machine learning-based models displayed an accuracy of 72.9%-83.9%. The Primary Aldosteronism Confirmatory Testing (PACT) score correctly classified 84.1% at training and 83.9% or 81.1% at internal and external validation, respectively. A flow chart employing the PACT score to select patients for confirmatory testing correctly managed all patients and resulted in a 22.8% reduction in the number of confirmatory tests. CONCLUSIONS The integration of diagnostic modeling algorithms in clinical practice may improve the management of patients with PA by circumventing unnecessary confirmatory testing.
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Affiliation(s)
- Jacopo Burrello
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Martina Amongero
- Department of Mathematical Sciences G. L. Lagrange, Polytechnic University of Torino, Torino, Italy
| | - Fabrizio Buffolo
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Elisa Sconfienza
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Vittorio Forestiero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alessio Burrello
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | - Christian Adolf
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Laura Handgriff
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Franco Veglio
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Tracy Ann Williams
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
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24
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Ohno Y, Naruse M, Beuschlein F, Schreiner F, Parasiliti-Caprino M, Deinum J, Drake WM, Fallo F, Fuss CT, Grytaas MA, Ichijo T, Inagaki N, Kakutani M, Kastelan D, Kraljevic I, Katabami T, Kocjan T, Monticone S, Mulatero P, O'Toole S, Kobayashi H, Sone M, Tsuiki M, Wada N, Williams TA, Reincke M, Tanabe A. Adrenal Venous Sampling-Guided Adrenalectomy Rates in Primary Aldosteronism: Results of an International Cohort (AVSTAT). J Clin Endocrinol Metab 2021; 106:e1400-e1407. [PMID: 33031550 DOI: 10.1210/clinem/dgaa706] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT Adrenal venous sampling (AVS) is the current criterion standard lateralization technique in primary aldosteronism (PA). Japanese registry data found that 30% of patients with unilateral PA did not undergo adrenalectomy, but the reasons for this and whether the same pattern is seen internationally are unknown. OBJECTIVE To assess the rate of AVS-guided adrenalectomy across an international cohort and identify factors that resulted in adrenalectomy not being performed in otherwise eligible patients. DESIGN, SETTING, AND PARTICIPANTS Retrospective, multinational, multicenter questionnaire-based survey of management of PA patients from 16 centers between 2006 and 2018. MAIN OUTCOME MEASURES Rates of AVS implementation, AVS success rate, diagnosis of unilateral PA, adrenalectomy rate, and reasons why adrenalectomy was not undertaken in patients with unilateral PA. RESULTS Rates of AVS implementation, successful AVS, and unilateral disease were 66.3%, 89.3% and 36.9% respectively in 4818 patients with PA. Unilateral PA and adrenalectomy rate in unilateral PA were lower in Japanese than in European centers (24.0% vs 47.6% and 78.2% vs 91.4% respectively). The clinical reasoning for not performing adrenalectomy in unilateral PA were more likely to be physician-derived in Japan and patient-derived in Europe. Physician-derived factors included non-AVS factors, such as good blood pressure control, normokalemia, and the absence of adrenal lesions on imaging, which were present before AVS. CONCLUSION Considering the various unfavorable aspects of AVS, stricter implementation and consideration of surgical candidacy prior to AVS will increase its diagnostic efficiency and utility.
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Affiliation(s)
- Youichi Ohno
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan
| | - Mitsuhide Naruse
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan
- Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan
- Division of Endocrinology and Metabolism, NHO Kyoto Medical Center, Kyoto, Japan
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zurich, Switzerland
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstr. München, Germany
| | - Florentine Schreiner
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zurich, Switzerland
| | - Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jaap Deinum
- Department of Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
| | - William M Drake
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
| | | | - Carmina T Fuss
- Department of Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
| | | | - Takamasa Ichijo
- Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan
| | - Miki Kakutani
- Department of Diabetes and Endocrinology, Hyogo Medical University, Hyogo, Japan
| | - Darko Kastelan
- Division of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ivana Kraljevic
- Division of Endocrinology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Takuyuki Katabami
- Division of Metabolism and Endocrinology, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan
| | - Tomaz Kocjan
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Sam O'Toole
- Department of Endocrinology, St Bartholomew's Hospital, London, UK
| | - Hiroki Kobayashi
- Division of Nephrology, Hypertension, and Endocrinology, Nihon University School of Medicine, Tokyo, Japan
| | - Masakatsu Sone
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mika Tsuiki
- Division of Endocrinology and Metabolism, NHO Kyoto Medical Center, Kyoto, Japan
| | - Norio Wada
- Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan
| | - Tracy Ann Williams
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstr. München, Germany
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstr. München, Germany
| | - Akiyo Tanabe
- Division of Diabetes and Endocrinology, National International Center for Global Health and Medicine, Tokyo, Japan
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Buffolo F, Cavaglià G, Burrello J, Amongero M, Tetti M, Pecori A, Sconfienza E, Veglio F, Mulatero P, Monticone S. Quality of life in primary aldosteronism: A prospective observational study. Eur J Clin Invest 2021; 51:e13419. [PMID: 32997795 DOI: 10.1111/eci.13419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies suggested that patients affected by primary aldosteronism (PA) have impaired quality of life (QOL) compared to the general population, but a direct comparison with patients affected by essential hypertension (EH) has never been performed. The aim of the study was to compare the QOL of patients affected by PA to the QOL of patients affected by EH. MATERIAL AND METHODS We designed a prospective observational study comparing the QOL of patients with PA and carefully matched patients with EH before and after treatment. We recruited 70 patients with PA and 70 patients with EH, matched for age, sex, blood pressure levels and intensity of antihypertensive treatment. We assessed QOL at baseline and after specific treatment for PA or after optimization of medical therapy for patients with EH. RESULTS Patients with PA displayed impaired QOL compared with the general healthy population, but similar to patients with EH. Both laparoscopic adrenalectomy and treatment with mineralocorticoid receptor antagonist allowed an improvement of QOL in patients with PA, that was more pronounced after surgical treatment. Optimization of blood pressure control by implementation of antihypertensive treatment (without MR antagonists) allowed a minimal improvement in only one of eight domains in patients with EH. CONCLUSIONS Patients with PA have impaired QOL, which is likely caused by uncontrolled hypertension and the effects of intensive antihypertensive treatment. Surgical and medical treatment of PA allows a significant improvement of QOL, by amelioration of blood pressure control and, after surgical treatment, by reduction of antihypertensive treatment.
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Affiliation(s)
- Fabrizio Buffolo
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Giovanni Cavaglià
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Jacopo Burrello
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Martina Amongero
- Department of Mathematical Sciences G. L. Lagrange, Polytechnic University of Torino, Torino, Italy
| | - Martina Tetti
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alessio Pecori
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Elisa Sconfienza
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
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Ruocco G, McCullough PA, Tecson KM, Mancone M, De Ferrari GM, D'Ascenzo F, De Rosa FG, Paggi A, Forleo G, Secco GG, Pistis G, Monticone S, Vicenzi M, Rota I, Blasi F, Pugliese F, Fedele F, Palazzuoli A. Mortality Risk Assessment Using CHA(2)DS(2)-VASc Scores in Patients Hospitalized With Coronavirus Disease 2019 Infection. Am J Cardiol 2020; 137:111-117. [PMID: 32991860 PMCID: PMC7521434 DOI: 10.1016/j.amjcard.2020.09.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022]
Abstract
Early risk stratification for complications and death related to Coronavirus disease 2019 (COVID-19) infection is needed. Because many patients with COVID-19 who developed acute respiratory distress syndrome have diffuse alveolar inflammatory damage associated with microvessel thrombosis, we aimed to investigate a common clinical tool, the CHA(2)DS(2)-VASc, to aid in the prognostication of outcomes for COVID-19 patients. We analyzed consecutive patients from the multicenter observational CORACLE registry, which contains data of patients hospitalized for COVID-19 infection in 4 regions of Italy, according to data-driven tertiles of CHA(2)DS(2)-VASc score. The primary outcomes were inpatient death and a composite of inpatient death or invasive ventilation. Of 1045 patients in the registry, 864 (82.7%) had data available to calculate CHA(2)DS(2)-VASc score and were included in the analysis. Of these, 167 (19.3%) died, 123 (14.2%) received invasive ventilation, and 249 (28.8%) had the composite outcome. Stratification by CHA(2)DS(2)-VASc tertiles (T1: ≤1; T2: 2 to 3; T3: ≥4) revealed increases in both death (8.1%, 24.3%, 33.3%, respectively; p <0.001) and the composite end point (18.6%, 31.9%, 43.5%, respectively; p <0.001). The odds ratios for mortality and the composite end point for T2 patients versus T1 CHA(2)DS(2)-VASc score were 3.62 (95% CI:2.29 to 5.73,p <0.001) and 2.04 (95% CI:1.42 to 2.93, p <0.001), respectively. Similarly, the odds ratios for mortality and the composite end point for T3 patients versus T1 were 5.65 (95% CI:3.54 to 9.01, p <0.001) and 3.36 (95% CI:2.30 to 4.90,p <0.001), respectively. In conclusion, among Italian patients hospitalized for COVID-19 infection, the CHA(2)DS(2)-VASc risk score for thromboembolic events enhanced the ability to achieve risk stratification for complications and death.
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Affiliation(s)
- Gaetano Ruocco
- Cardiology Division, Regina Montis Regalis Hospital, Mondovì, Cuneo, Italy
| | - Peter A McCullough
- Baylor Heart and Vascular Institute, Dallas, Texas; Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Dallas, Texas; Baylor University Medical Center, Dallas, Texas; Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza, University of Rome, Rome, Italy
| | - Gaetano M De Ferrari
- Cardiology, Department of Medical Science University of Turin, Città della Salute e Della Scienza Le Molinette Hospital Torino, Torino, Italy
| | - Fabrizio D'Ascenzo
- Cardiology, Department of Medical Science University of Turin, Città della Salute e Della Scienza Le Molinette Hospital Torino, Torino, Italy
| | - Francesco G De Rosa
- Infectious Disease, Department of Medical Sciences, University of Torino, AOU Città della salute e della Scienza, Torino, Italy
| | - Anita Paggi
- Interventional Cardiology Department of Internal Medicine, ASSST Nord Milano E Bassini Hospital Cisanello Balsamo, Milan, Italy
| | - Giovanni Forleo
- Section Head Electrophysiology and Cardiac Pacing Azienda Ospedaliera, Polo Universitario -"Luigi Sacco," Milano, Italy
| | - Gioel G Secco
- Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gianfranco Pistis
- Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Silvia Monticone
- Division of Internal Medicine, Department of Medical Sciences University of Turin, Turin, Italy
| | - Marco Vicenzi
- Cardiovascular Disease Unit, Department of Internal Medicine, University of Milano, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Irene Rota
- Cardiovascular Disease Unit, Department of Internal Medicine, University of Milano, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis Center, Department of Internal Medicine, University of Milano, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesco Pugliese
- Department of General Surgery, Surgical Specialities "Paride Stefanini," Rome Italy
| | - Francesco Fedele
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza, University of Rome, Rome, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, Le Scotte Hospital, University of Siena, Siena, Italy.
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Burrello J, Burrello A, Pieroni J, Sconfienza E, Forestiero V, Amongero M, Rossato D, Veglio F, Williams TA, Monticone S, Mulatero P. Prediction of hyperaldosteronism subtypes when adrenal vein sampling is unilaterally successful. Eur J Endocrinol 2020; 183:657-667. [PMID: 33112264 DOI: 10.1530/eje-20-0656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/25/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adrenal venous sampling (AVS) is the gold standard to discriminate patients with unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically demanding and in cases of unsuccessful cannulation of adrenal veins, the results may not always be interpreted. The aim of our study was to develop diagnostic models to distinguish UPA from BPA, in cases of unilateral successful AVS and the presence of contralateral suppression of aldosterone secretion. DESIGN Retrospective evaluation of 158 patients referred to a tertiary hypertension unit who underwent AVS. We randomly assigned 110 patients to a training cohort and 48 patients to a validation cohort to develop and test the diagnostic models. METHODS Supervised machine learning algorithms and regression models were used to develop and validate two prediction models and a simple 19-point score system to stratify patients according to their subtype diagnosis. RESULTS Aldosterone levels at screening and after confirmatory testing, lowest potassium, ipsilateral and contralateral imaging findings at CT scanning, and contralateral ratio at AVS, were associated with a diagnosis of UPA and were included in the diagnostic models. Machine learning algorithms correctly classified the majority of patients both at training and validation (accuracy: 82.9-95.7%). The score system displayed a sensitivity/specificity of 95.2/96.9%, with an AUC of 0.971. A flow-chart integrating our score correctly managed all patients except 3 (98.1% accuracy), avoiding the potential repetition of 77.2% of AVS procedures. CONCLUSIONS Our score could be integrated in clinical practice and guide surgical decision-making in patients with unilateral successful AVS and contralateral suppression.
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Affiliation(s)
- Jacopo Burrello
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alessio Burrello
- Department of Electrical, Electronic and Information Engineering 'Guglielmo Marconi' (DEI), University of Bologna, Bologna, Italy
| | - Jacopo Pieroni
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Elisa Sconfienza
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Vittorio Forestiero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Martina Amongero
- Department of Mathematical Sciences G. L. Lagrange, Polytechnic University of Torino, Torino, Italy
| | - Denis Rossato
- AOU Città della Salute e della Scienza - Service of Radiology, Torino, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Tracy A Williams
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
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Barbero U, Moncalvo C, Trabattoni D, Pavani M, Amoroso GR, Bocchino PP, Truffa Giachet A, Saglietto A, Monticone S, Secco GG, Campo G, Verardi R, Iannaccone M, Galvani M, Ugo F, Infantino V, Olivotti L, Mennuni M, Vercellino M, Gili S, Zucchetti O, Casella G, Giammaria M, De Benedictis M, Tolomeo P, Doronzo B, Grosso Marra W, Rognoni A, Montefusco A, Patti G, Mancone M, De Ferrari GM, D’Ascenzo F. Gender differences in acute coronary syndromes patterns during the COVID-19 outbreak. Am J Cardiovasc Dis 2020; 10:506-513. [PMID: 33224602 PMCID: PMC7675165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Mortality from acute coronary syndromes (ACS) is strictly related to early management. As female patients usually experience longer delays before diagnosis and treatment, we assessed whether women were more affected by the dramatic drop in hospital admissions for ACS during the Covid-19 pandemic. METHODS We performed a retrospective analysis of clinical and angiographic characteristics of consecutive patients who were admitted for ACS at 15 hospitals in Northern Italy comparing men and women data. The study period was defined as the time between the first confirmed case of Covid-19 in Italy (February 20, 2020) and March 31, 2020. We compared hospitalization rates between the study period and two control periods: the corresponding period during the previous year (February 20 to March 31, 2019) and the earlier period during the same year (January 1 to February 19, 2020). Incidence rate ratios comparing the study period with each of the control periods were calculated with the use of Poisson regression. RESULTS Of the 547 patients who were hospitalized for ACS during the study period, only 127 (23%) were females, accounting for a mean of 3.1 admissions per day, while ACS hospitalized males were 420, with a mean of 10.2 admissions per day. There was a significant decrease driven by a similar reduction in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) diagnosis in both sexes compared to the control periods. A trend toward a greater reduction in admitted females was shown in the intra-year control period (46% admission reduction in females vs 37% in males, with females accounting for 26% of ACS, P=0.10) and a significant reduction when compared to the previous year control period (40% admission reduction in females vs 23% in males, with females accounting for 28% of ACS, P=0.03), mainly related to Unstable Angina diagnosis. CONCLUSION The Covid-19 pandemic period closed the gap between men and women in ACS, with similar rates of reduction of hospitalized STEMI and NSTEMI and a trend toward greater reduction in UA admission among women. Furthermore, many typical differences between males and females regarding ischemic heart disease presentations and vessel distribution were leveled.
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Affiliation(s)
| | | | - Daniela Trabattoni
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, University of MilanItaly
| | | | | | - Pier Paolo Bocchino
- Division of Cardiology, A.O.U Città della Salute e della Scienza di TorinoTurin, Italy
| | | | - Andrea Saglietto
- Division of Cardiology, A.O.U Città della Salute e della Scienza di TorinoTurin, Italy
| | - Silvia Monticone
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of TurinTorino, Italy
| | - Gioel Gabrio Secco
- Department of Cardiology, Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare ArrigoAlessandria, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di FerraraFerrara, Italy
- Maria Cecilia Hospital, GVM Care & ResearchCotignola, Ravenna Italy
| | - Roberto Verardi
- Division of Cardiology, A.O.U Città della Salute e della Scienza di TorinoTurin, Italy
- Department of Cardiology, Maggiore Hospital Carlo Alberto PizzardiBologna, Italy
| | | | - Marcello Galvani
- U.O.C. Cardiologia, Dipartimento Cardiovascolare AUSL Romagna, Ospedale Morgagni, Forlì, e Unità di Ricerca Cardiovascolare, Fondazione Cardiologica SaccoForlì, Italy
| | - Fabrizio Ugo
- Division of Cardiology, Presidio Ospedaliero Sant’Andrea di VercelliVercelli, Italy
| | | | - Luca Olivotti
- Division of Cardiology, Ospedale Santa CoronaPietra Ligure, Italy
| | - Marco Mennuni
- Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della CaritàNovara, Italy
| | - Matteo Vercellino
- Department of Cardiology, Interventional Cardiology and Cardiac Surgery Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare ArrigoAlessandria, Italy
| | - Sebastiano Gili
- Department of Cardiovascular Sciences, IRCCS Centro Cardiologico Monzino, University of MilanItaly
| | - Ottavio Zucchetti
- Cardiology Unit, Azienda Ospedaliera Universitaria di FerraraFerrara, Italy
| | - Gianni Casella
- Department of Cardiology, Maggiore Hospital Carlo Alberto PizzardiBologna, Italy
| | | | | | - Paolo Tolomeo
- Cardiology Unit, Azienda Ospedaliera Universitaria di FerraraFerrara, Italy
| | | | | | - Andrea Rognoni
- Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della CaritàNovara, Italy
| | - Antonio Montefusco
- Division of Cardiology, A.O.U Città della Salute e della Scienza di TorinoTurin, Italy
| | - Giuseppe Patti
- Coronary Care Unit and Catheterization laboratory, A.O.U. Maggiore della CaritàNovara, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of RomeRome, Italy
| | | | - Fabrizio D’Ascenzo
- Division of Cardiology, A.O.U Città della Salute e della Scienza di TorinoTurin, Italy
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Palazzuoli A, Mancone M, De Ferrari GM, Forleo G, Secco GG, Ruocco GM, D'Ascenzo F, Monticone S, Paggi A, Vicenzi M, Palazzo AG, Landolina M, Taravelli E, Tavazzi G, Blasi F, Infusino F, Fedele F, De Rosa FG, Emmett M, Schussler JM, Tecson KM, McCullough PA. Antecedent Administration of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists and Survival After Hospitalization for COVID-19 Syndrome. J Am Heart Assoc 2020; 9:e017364. [PMID: 33023356 PMCID: PMC7763715 DOI: 10.1161/jaha.120.017364] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) utilizes the angiotensin-converting enzyme-2 (ACE-2) receptor to enter human cells. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARB) are associated with ACE-2 upregulation. We hypothesized that antecedent use of ACEI/ARB may be associated with mortality in coronavirus disease 2019 (COVID-19). Methods and Results We used the Coracle registry, which contains data of patients hospitalized with COVID-19 in 4 regions of Italy, and restricted analyses to those ≥50 years of age. The primary outcome was in-hospital mortality. Among these 781 patients, 133 (17.0%) used an ARB and 171 (21.9%) used an ACEI. While neither sex nor smoking status differed by user groups, patients on ACEI/ARB were older and more likely to have hypertension, diabetes mellitus, and congestive heart failure. The overall mortality rate was 15.1% (118/781) and increased with age (PTrend<0.0001). The crude odds ratios (ORs) for death for ACEI users and ARB users were 0.98, 95% CI, 0.60-1.60, P=0.9333, and 1.13, 95% CI, 0.67-1.91, P=0.6385, respectively. After adjusting for age, hypertension, diabetes mellitus, and congestive heart failure, antecedent ACEI administration was associated with reduced mortality (OR, 0.55; 95% CI, 0.31-0.98, P=0.0436); a similar, but weaker trend was observed for ARB administration (OR, 0.58; 95% CI, 0.32-1.07, P=0.0796). Conclusions In those aged ≥50 years hospitalized with COVID-19, antecedent use of ACEI was independently associated with reduced risk of inpatient death. Our findings suggest a protective role of renin-angiotensin-aldosterone system inhibition in patients with high cardiovascular risk affected by COVID-19.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases UnitDepartment of Medical SciencesAOUS Le Scotte Hospital University of SienaItaly
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular SciencesSapienza, University of RomeItaly
| | - Gaetano M. De Ferrari
- CardiologyDepartment of Medical Science,University of TurinCittà della Salute e Della Scienza Le Molinette Hospital TorinoTorinoItaly
| | - Giovanni Forleo
- Section Head Electrophysiology and Cardiac Pacing Azienda Ospedaliera ‐ Polo Universitario ‐ "Luigi Sacco"MilanoItaly
| | - Gioel G. Secco
- Interventional Cardiology and Cardiac Surgery UnitAzienda Ospedaliera SS Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | | | - Fabrizio D'Ascenzo
- CardiologyDepartment of Medical Science,University of TurinCittà della Salute e Della Scienza Le Molinette Hospital TorinoTorinoItaly
| | - Silvia Monticone
- Division of Internal MedicineDepartment of Medical SciencesUniversity of TurinItaly
| | - Anita Paggi
- Interventional CardiologyDepartment of Internal MedicineASSST Nord Milano E Bassini Hospital Cisanello BalsamoMilanItaly
| | - Marco Vicenzi
- Cardiovascular Disease UnitDepartment of Internal MedicineFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversity of MilanoItaly
| | - Anna G. Palazzo
- Infectious DiseaseDepartment of Medical SciencesAOU Città Della Salute e Della ScienzaUniversity of TorinoItaly
| | | | | | - Guido Tavazzi
- Intensive CareFondation IRCCS Policlinico San MatteoUniversity of PaviaItaly
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis CenterDepartment of Internal MedicineFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversity of MilanoItaly
| | - Fabio Infusino
- Department of Clinical Internal, Anesthesiological and Cardiovascular SciencesSapienza, University of RomeItaly
| | - Francesco Fedele
- Department of Clinical Internal, Anesthesiological and Cardiovascular SciencesSapienza, University of RomeItaly
| | - Francesco G. De Rosa
- Infectious DiseaseDepartment of Medical SciencesAOU Città Della Salute e Della ScienzaUniversity of TorinoItaly
| | | | - Jeffrey M. Schussler
- Baylor University Medical CenterDallasTX
- Baylor Scott and White Heart and Vascular HospitalDallasTX
- Baylor Heart and Vascular InstituteDallasTX
| | - Kristen M. Tecson
- Baylor University Medical CenterDallasTX
- Baylor Scott and White Heart and Vascular HospitalDallasTX
- Baylor Heart and Vascular InstituteDallasTX
| | - Peter A. McCullough
- Baylor University Medical CenterDallasTX
- Baylor Scott and White Heart and Vascular HospitalDallasTX
- Baylor Heart and Vascular InstituteDallasTX
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Burrello J, Burrello A, Pieroni J, Sconfienza E, Forestiero V, Rabbia P, Adolf C, Reincke M, Veglio F, Williams TA, Monticone S, Mulatero P. Development and Validation of Prediction Models for Subtype Diagnosis of Patients With Primary Aldosteronism. J Clin Endocrinol Metab 2020; 105:5860167. [PMID: 32561919 DOI: 10.1210/clinem/dgaa379] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/11/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT Primary aldosteronism (PA) comprises unilateral (lateralized [LPA]) and bilateral disease (BPA). The identification of LPA is important to recommend potentially curative adrenalectomy. Adrenal venous sampling (AVS) is considered the gold standard for PA subtyping, but the procedure is available in few referral centers. OBJECTIVE To develop prediction models for subtype diagnosis of PA using patient clinical and biochemical characteristics. DESIGN, PATIENTS AND SETTING Patients referred to a tertiary hypertension unit. Diagnostic algorithms were built and tested in a training (N = 150) and in an internal validation cohort (N = 65), respectively. The models were validated in an external independent cohort (N = 118). MAIN OUTCOME MEASURE Regression analyses and supervised machine learning algorithms were used to develop and validate 2 diagnostic models and a 20-point score to classify patients with PA according to subtype diagnosis. RESULTS Six parameters were associated with a diagnosis of LPA (aldosterone at screening and after confirmatory testing, lowest potassium value, presence/absence of nodules, nodule diameter, and computed tomography results) and were included in the diagnostic models. Machine learning algorithms displayed high accuracy at training and internal validation (79.1%-93%), whereas a 20-point score reached an area under the curve of 0.896, and a sensitivity/specificity of 91.7/79.3%. An integrated flowchart correctly addressed 96.3% of patients to surgery and would have avoided AVS in 43.7% of patients. The external validation on an independent cohort confirmed a similar diagnostic performance. CONCLUSIONS Diagnostic modelling techniques can be used for subtype diagnosis and guide surgical decision in patients with PA in centers where AVS is unavailable.
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Affiliation(s)
- Jacopo Burrello
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy
| | - Alessio Burrello
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Italy
| | - Jacopo Pieroni
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy
| | - Elisa Sconfienza
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy
| | - Vittorio Forestiero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy
| | - Paola Rabbia
- Division of Radiology, University of Torino, Italy
| | - Christian Adolf
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Franco Veglio
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy
| | - Tracy Ann Williams
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Italy
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Mulatero P, Monticone S, Deinum J, Amar L, Prejbisz A, Zennaro MC, Beuschlein F, Rossi GP, Nishikawa T, Morganti A, Seccia TM, Lin YH, Fallo F, Widimsky J. Genetics, prevalence, screening and confirmation of primary aldosteronism: a position statement and consensus of the Working Group on Endocrine Hypertension of The European Society of Hypertension. J Hypertens 2020; 38:1919-1928. [PMID: 32890264 DOI: 10.1097/hjh.0000000000002510] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
: Autonomous aldosterone overproduction represents the underlying condition of 5-10% of patients with arterial hypertension and carries a significant burden of mortality and morbidity. The diagnostic algorithm for primary aldosteronism is sequentially based on hormonal tests (screening and confirmation tests), followed by lateralization studies (adrenal CT scanning and adrenal venous sampling) to distinguish between unilateral and bilateral disease. Despite the recommendations of the Endocrine Society guideline, primary aldosteronism is largely underdiagnosed and undertreated with high between-centre heterogeneity. Experts from the European Society of Hypertension have critically reviewed the available literature and prepared a consensus document constituting two articles to summarize current knowledge on the epidemiology, diagnosis, treatment, and complications of primary aldosteronism.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Medicine III, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Laurence Amar
- Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital européen Georges-Pompidou, Université de Paris, PARCC, Inserm, Paris, France
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Maria-Christina Zennaro
- Université de Paris, PARCC, INSERM, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Gian Paolo Rossi
- Hypertension Unit and Specialized Center for Blood Pressure Disorders - Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Tetsuo Nishikawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Ospedale Policlinico, Università di Milano, Milan, Italy
| | - Teresa Maria Seccia
- Hypertension Unit and Specialized Center for Blood Pressure Disorders - Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Yen-Hung Lin
- Division of cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Francesco Fallo
- Department of Medicine -DIMED, University of Padova, Padova, Italy
| | - Jiri Widimsky
- 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Burrello J, Bolis S, Balbi C, Burrello A, Provasi E, Caporali E, Gauthier LG, Peirone A, D'Ascenzo F, Monticone S, Barile L, Vassalli G. An extracellular vesicle epitope profile is associated with acute myocardial infarction. J Cell Mol Med 2020; 24:9945-9957. [PMID: 32666618 PMCID: PMC7520329 DOI: 10.1111/jcmm.15594] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 12/16/2022] Open
Abstract
The current standard biomarker for myocardial infarction (MI) is high-sensitive troponin. Although powerful in clinical setting, search for new markers is warranted as early diagnosis of MI is associated with improved outcomes. Extracellular vesicles (EVs) attracted considerable interest as new blood biomarkers. A training cohort used for diagnostic modelling included 30 patients with STEMI, 38 with stable angina (SA) and 30 matched-controls. Extracellular vesicle concentration was assessed by nanoparticle tracking analysis. Extracellular vesicle surface-epitopes were measured by flow cytometry. Diagnostic models were developed using machine learning algorithms and validated on an independent cohort of 80 patients. Serum EV concentration from STEMI patients was increased as compared to controls and SA. EV levels of CD62P, CD42a, CD41b, CD31 and CD40 increased in STEMI, and to a lesser extent in SA patients. An aggregate marker including EV concentration and CD62P/CD42a levels achieved non-inferiority to troponin, discriminating STEMI from controls (AUC = 0.969). A random forest model based on EV biomarkers discriminated the two groups with 100% accuracy. EV markers and RF model confirmed high diagnostic performance at validation. In conclusion, patients with acute MI or SA exhibit characteristic EV biomarker profiles. EV biomarkers hold great potential as early markers for the management of patients with MI.
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Affiliation(s)
- Jacopo Burrello
- Laboratory of Cellular and Molecular CardiologyCardiocentro Ticino and Foundation for Cardiovascular Research and Education (FCRE)LuganoSwitzerland
| | - Sara Bolis
- Laboratory of Cellular and Molecular CardiologyCardiocentro Ticino and Foundation for Cardiovascular Research and Education (FCRE)LuganoSwitzerland
- Laboratory for Cardiovascular TheranosticsCardiocentro Ticino and Foundation for Cardiovascular Research and Education (FCRE)LuganoSwitzerland
| | - Carolina Balbi
- Laboratory of Cellular and Molecular CardiologyCardiocentro Ticino and Foundation for Cardiovascular Research and Education (FCRE)LuganoSwitzerland
| | - Alessio Burrello
- Department of ElectricalElectronic and Information Engineering "Guglielmo Marconi" (DEI)University of BolognaBolognaItaly
| | - Elena Provasi
- Laboratory of Cellular and Molecular CardiologyCardiocentro Ticino and Foundation for Cardiovascular Research and Education (FCRE)LuganoSwitzerland
| | - Elena Caporali
- Laboratory of Cellular and Molecular CardiologyCardiocentro Ticino and Foundation for Cardiovascular Research and Education (FCRE)LuganoSwitzerland
| | - Lorenzo Grazioli Gauthier
- Laboratory of Cellular and Molecular CardiologyCardiocentro Ticino and Foundation for Cardiovascular Research and Education (FCRE)LuganoSwitzerland
| | - Andrea Peirone
- Division of CardiologyDepartment of Medical SciencesUniversity of TorinoTorinoItaly
| | - Fabrizio D'Ascenzo
- Division of CardiologyDepartment of Medical SciencesUniversity of TorinoTorinoItaly
| | - Silvia Monticone
- Division of Internal MedicineDepartment of Medical SciencesUniversity of TorinoTorinoItaly
| | - Lucio Barile
- Laboratory for Cardiovascular TheranosticsCardiocentro Ticino and Foundation for Cardiovascular Research and Education (FCRE)LuganoSwitzerland
- Faculty of Biomedical SciencesUniversità della Svizzera Italiana (USI)LuganoSwitzerland
- Institute of Life ScienceScuola Superiore Sant'AnnaPisaItaly
| | - Giuseppe Vassalli
- Laboratory of Cellular and Molecular CardiologyCardiocentro Ticino and Foundation for Cardiovascular Research and Education (FCRE)LuganoSwitzerland
- Faculty of Biomedical SciencesUniversità della Svizzera Italiana (USI)LuganoSwitzerland
- Center for Molecular CardiologyUniversity of ZurichZurichSwitzerland
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De Filippo O, D'Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, Secco GG, Campo G, Gallone G, Verardi R, Gaido L, Iannaccone M, Galvani M, Ugo F, Barbero U, Infantino V, Olivotti L, Mennuni M, Gili S, Infusino F, Vercellino M, Zucchetti O, Casella G, Giammaria M, Boccuzzi G, Tolomeo P, Doronzo B, Senatore G, Grosso Marra W, Rognoni A, Trabattoni D, Franchin L, Borin A, Bruno F, Galluzzo A, Gambino A, Nicolino A, Truffa Giachet A, Sardella G, Fedele F, Monticone S, Montefusco A, Omedè P, Pennone M, Patti G, Mancone M, De Ferrari GM. Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy. N Engl J Med 2020; 383:88-89. [PMID: 32343497 PMCID: PMC7224608 DOI: 10.1056/nejmc2009166] [Citation(s) in RCA: 742] [Impact Index Per Article: 185.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ovidio De Filippo
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Filippo Angelini
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pier Paolo Bocchino
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federico Conrotto
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Saglietto
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gioel Gabrio Secco
- Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gianluca Campo
- Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Guglielmo Gallone
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberto Verardi
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | - Fabrizio Ugo
- Presidio Ospedaliero Sant'Andrea di Vercelli, Vercelli, Italy
| | | | | | | | - Marco Mennuni
- Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | | | | | - Matteo Vercellino
- Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Gianni Casella
- Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | | | | | - Paolo Tolomeo
- Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | | | | | | | - Andrea Rognoni
- Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy
| | | | - Luca Franchin
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Borin
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Bruno
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | | | | | | | - Antonio Montefusco
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Pierluigi Omedè
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mauro Pennone
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
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Abstract
CONTEXT The clinical spectrum and knowledge of the molecular mechanisms underlying primary aldosteronism (PA), the most frequent form of endocrine hypertension, has evolved over recent years. In accordance with the Endocrine Society guidelines and in light of the growing evidence showing adverse cardiovascular outcomes, it is expected that a progressively wider population of patients affected by hypertension will be screened for PA, including the elderly. EVIDENCE ACQUISITION A systematic search of PubMed was undertaken for studies related to the renin-angiotensin-aldosterone system (RAAS), PA, and adrenal histopathology in the elderly population. EVIDENCE SYNTHESIS Several studies showed an age-dependent decrease in the activity of RAAS, together with a progressive decrease of the aldosterone response to sodium intake, particularly after the sixth decade of life. The positive correlation between age and serum aldosterone during liberal sodium intake over serum aldosterone during sodium restriction is paralleled by histological changes in adrenal aldosterone synthase (CYP11B2) expression patterns. Immunohistochemical studies showed a progressive loss of the continuous expression of CYP11B2 in the adrenal zona glomerulosa with aging and a concomitant increase of aldosterone-producing cell clusters, which might be responsible for relatively autonomous aldosterone production. Additionally, following PA confirmation and subtype diagnosis, older age is correlated with a lower benefit after adrenalectomy for unilateral PA. CONCLUSIONS Accumulating evidence suggests that RAAS physiology and regulation show age-related changes. Further studies may investigate to what extent these variations might affect the diagnostic workup of patients affected by PA.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jacopo Burrello
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Tracy Ann Williams
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
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Pecori A, Buffolo F, Pieroni J, Forestiero V, Sconfienza E, Veglio F, Mulatero P, Monticone S. Primary Aldosteronism and Obstructive Sleep Apnea: Casual Association or Pathophysiological Link? Horm Metab Res 2020; 52:366-372. [PMID: 32219799 DOI: 10.1055/a-1133-7255] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The coexistence of aldosterone oversecretion and obstructive sleep apnea is frequently observed, especially in patients with resistant hypertension, obesity, and metabolic syndrome. Since aldosterone excess and sleep apnea are both independently associated with an increased risk of cardiovascular disease, to investigate whether their coexistence might be attributed to common predisposing conditions, such as metabolic disorders, or to an actual pathophysiological interconnection appears of great importance. Fluid overload and metabolic abnormalities relating to aldosterone oversecretion may be implicated in obstructive sleep apnea development. Nocturnal intermittent hypoxia may in turn exacerbate renin-angiotensin-aldosterone system activity, thus leading to hyperaldosteronism. Furthermore, fat tissue excess and adipocyte secretory products might predispose to both sleep apnea and aldosterone oversecretion in subjects with obesity. Consistent with these evidences, obstructive sleep apnea frequently affects patients with primary aldosteronism. Conversely, whether primary aldosteronism is more prevalent in individuals affected by obstructive sleep apnea compared to the general population remains controversial.
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Affiliation(s)
- Alessio Pecori
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Fabrizio Buffolo
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Jacopo Pieroni
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Vittorio Forestiero
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Elisa Sconfienza
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Franco Veglio
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
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Burrello J, Buffolo F, Domenig O, Tetti M, Pecori A, Monticone S, Poglitsch M, Mulatero P. SUN-LB98 RAAS Triple-A Analysis for the Screening of Primary Aldosteronism. J Endocr Soc 2020. [PMCID: PMC7208392 DOI: 10.1210/jendso/bvaa046.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary aldosteronism (PA) is recognized as the most frequent cause of secondary hypertension, and its screening is expected to become a routine evaluation in most patients with hypertension. The interference of antihypertensive therapies with the aldosterone-to-renin ratio (ARR) during screening process is a major confounder. Renin-Angiotensin-Aldosterone System Triple-A (RAAS Triple-A) testing is a novel mass-spectrometry based assay for quantification of Angiotensin I (Ang I), Angiotenisn II (Ang II) and Aldosterone in a single sample of serum by RAAS equilibrium analysis. Obtained hormone levels are used to calculate markers for plasma-renin-activity (PRA-S, Ang I + Ang II), plasma angiotensin-converting-enzyme activity (ACE-S, Ang II-to-Ang I ratio) and adrenal function (AA2-Ratio, Aldosterone-to-Ang II ratio), with the latter being useful to screen for PA in hypertension. We performed a comparative evaluation of the diagnostic performance of the AA2-Ratio and 5 renin-based diagnostic ratios, differing in methods to determine aldosterone levels and renin activity in a cohort of 110 patients with hypertension (33 patients with confirmed primary aldosteronism and 77 with essential hypertension). All ratios showed comparable areas under the curves ranging between 0.924 and 0.970 without significant differences between each other. The evaluation of the ACE-S revealed persistent drug intake in some patients as cause for suppressed renin-based diagnostic ratios, while the AA2-Ratio remained unaffected. The Youden index optimal cutoff value for the AA2-Ratio was 6.6 ([pmol/L]/[pmol/L]) with a sensitivity of 90% and a specificity of 93%, proving non-inferiority compared with the ARR while pointing to the potential for an interference-free application in patients under ACE inhibitor therapy. This study shows for the first time the accuracy and reliability of RAAS Triple-A analysis for the screening of primary aldosteronism that can be applied in clinical routine.
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Abstract
Low-renin hypertension (LRH) is a frequent condition in patients with arterial hypertension, accounting for 30% of patients. Monogenic forms can cause LRH in a minority of cases. However, in the large majority of patients, LRH is caused by the combined effects of congenital and acquired factors, comprising dietary habits. Several genetic variants have been proposed as co-factors in the pathogenesis of LRH with normal-low serum aldosterone. Emerging evidences support the hypothesis that a large proportion of LRH with normal-high serum aldosterone is associated with subclinical primary aldosteronism (PA). The recent identification of aldosterone-producing cell clusters (APCCs) as the possible cause of subclinical PA, further supported the concept of a continuous spectrum of autonomous aldosterone secretion, from subclinical forms towards overt PA. In this review we describe the main aspects of LRH, focusing on molecular basis, clinical risk profile and patients' management.
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Affiliation(s)
- Fabrizio Buffolo
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - Alessio Pecori
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - Jacopo Pieroni
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - Isabel Losano
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - Giovanni Cavaglià
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - Martina Tetti
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy.
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Rossi GP, Bisogni V, Bacca AV, Belfiore A, Cesari M, Concistrè A, Del Pinto R, Fabris B, Fallo F, Fava C, Ferri C, Giacchetti G, Grassi G, Letizia C, Maccario M, Mallamaci F, Maiolino G, Manfellotto D, Minuz P, Monticone S, Morganti A, Muiesan ML, Mulatero P, Negro A, Parati G, Pengo MF, Petramala L, Pizzolo F, Rizzoni D, Rossitto G, Veglio F, Seccia TM. The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism. Int J Cardiol Hypertens 2020; 5:100029. [PMID: 33447758 PMCID: PMC7803025 DOI: 10.1016/j.ijchy.2020.100029] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
Background and aim Considering the amount of novel knowledge generated in the last five years, a team of experienced hypertensionlogists was assembled to furnish updated clinical practice guidelines for the management of primary aldosteronism. Methods To identify the most relevant studies, the authors utilized a systematic literature review in international databases by applying the PICO strategy, and then they were required to make use of only those meeting predefined quality criteria. For studies of diagnostic tests, only those that fulfilled the Standards for Reporting of Diagnostic Accuracy recommendations were considered. Results Each section was jointly prepared by at least two co-authors, who provided Class of Recommendation and Level of Evidence following the American Heart Association methodology. The guidelines were sponsored by the Italian Society of Arterial Hypertension and underwent two rounds of revision, eventually reexamined by an External Committee. They were presented and thoroughly discussed in two face-to-face meetings with all co-authors and then presented on occasion of the 36th Italian Society of Arterial Hypertension meeting in order to gather further feedbacks by all members. The text amended according to these feedbacks was subjected to a further peer review. Conclusions After this process, substantial updated information was generated, which could simplify the diagnosis of primary aldosteronism and assist practicing physicians in optimizing treatment and follow-up of patients with one of the most common curable causes of arterial hypertension.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
- Corresponding author. DIMED –Clinica dell’Ipertensione Arteriosa, University Hospital, via Giustiniani, 2; 35126, Padova, Italy.
| | - Valeria Bisogni
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | | | - Anna Belfiore
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | - Antonio Concistrè
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Rita Del Pinto
- University of L'Aquila, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, L'Aquila, Italy
| | - Bruno Fabris
- Department of Medical Sciences, Università degli Studi di Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Francesco Fallo
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Italy
| | - Cristiano Fava
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Claudio Ferri
- University of L'Aquila, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, L'Aquila, Italy
| | | | | | - Claudio Letizia
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Mauro Maccario
- Endocrinology, Diabetology, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesca Mallamaci
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | - Dario Manfellotto
- UO Medicina Interna, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Pietro Minuz
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Silvia Monticone
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Ospedale Policlinico, Università Milano, Milan, Italy
| | - Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Paolo Mulatero
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Aurelio Negro
- Department of Medicine, Center for Hypertension, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Martino F. Pengo
- Department of Medicine and Surgery, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luigi Petramala
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Francesca Pizzolo
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Giacomo Rossitto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Franco Veglio
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Teresa Maria Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
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Burrello J, Monticone S, Losano I, Cavaglià G, Buffolo F, Tetti M, Covella M, Rabbia F, Veglio F, Pasini B, Williams TA, Mulatero P. Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension Unit. Hypertension 2020; 75:1025-1033. [PMID: 32114853 DOI: 10.1161/hypertensionaha.119.14063] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Primary aldosteronism (PA) was considered a rare disorder almost always associated with hypokalemia. The widespread screening of patients with hypertension unveiled an increased prevalence of PA with normokalemic hypertension the prevailing phenotype. Many studies have reported the prevalence of hypokalemia in patients with PA; conversely, the prevalence of PA in patients with hypokalemia is unknown. In this retrospective observational study, we define the prevalence of hypokalemia in referred patients with hypertension and the prevalence of PA in patients with hypokalemia and hypertension. Hypokalemia was present in 15.8% of 5100 patients with hypertension, whereas 76.9% were normokalemic, and 7.3% hyperkalemic. The prevalence of PA in patients with hypokalemia was 28.1% and increased with decreasing potassium concentrations up to 88.5% of patients with spontaneous hypokalemia and potassium concentrations <2.5 mmol/L. A multivariate regression analysis demonstrated the association of hypokalemia with the occurrence of cardiovascular events independent of PA diagnosis. An association of PA with the occurrence of cardiovascular events and target organ damage independent of hypokalemia was also demonstrated. In conclusion, our results confirm that PA is a frequent cause of secondary hypertension in patients with hypokalemia, and the presence of hypertension and spontaneous hypokalemia are strong indications for PA diagnosis. Finally, we show that PA and hypokalemia are associated with an increased risk of cardiovascular events.
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Affiliation(s)
- Jacopo Burrello
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Silvia Monticone
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Isabel Losano
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Giovanni Cavaglià
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Fabrizio Buffolo
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Martina Tetti
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Michele Covella
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Franco Rabbia
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Franco Veglio
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
| | - Barbara Pasini
- Medical Genetics Unit (B.P.), Department of Medical Sciences, University of Turin, Italy
| | - Tracy Ann Williams
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy.,Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Germany (T.A.W.)
| | - Paolo Mulatero
- From the Division of Internal Medicine and Hypertension (J.B., S.M., I.L., G.C., F.B., M.T., M.C., F.R., F.V., T.A.W., P.M.), Department of Medical Sciences, University of Turin, Italy
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40
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Ono Y, Yamazaki Y, Omata K, Else T, Tomlins SA, Rhayem Y, Williams TA, Reincke M, Carling T, Monticone S, Mulatero P, Beuschlein F, Ito S, Satoh F, Rainey WE, Sasano H. Histological Characterization of Aldosterone-producing Adrenocortical Adenomas with Different Somatic Mutations. J Clin Endocrinol Metab 2020; 105:5649299. [PMID: 31789380 PMCID: PMC7048684 DOI: 10.1210/clinem/dgz235] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Aldosterone-producing adrenocortical adenomas (APAs) are mainly composed of clear (lipid rich) and compact (eosinophilic) tumor cells. The detailed association between these histological features and somatic mutations (KCNJ5, ATP1A1, ATP2B3, and CACNA1D) in APAs is unknown. OBJECTIVE To examine the association between histological features and individual genotypes in APAs. METHODS Examination of 39 APAs subjected to targeted next-generation sequencing (11 KCNJ5, 10 ATP1A1, 10 ATP2B3, and 8 CACNA1D) and quantitative morphological and immunohistochemical (CYP11B2 and CYP17A1) analyses using digital imaging software. RESULTS KCNJ5- and ATP2B3-mutated APAs had clear cell dominant features (KCNJ5: clear 59.8% [54.4-64.6%] vs compact 40.2% (35.4-45.6%), P = .0022; ATP2B3: clear 54.3% [48.2-62.4 %] vs compact 45.7% (37.6-51.8 %), P = .0696). ATP1A1- and CACNA1D-mutated APAs presented with marked intratumoral heterogeneity. A significantly positive correlation of immunoreactivity was detected between CYP11B2 and CYP17A1 in tumor cells of KCNJ5-mutated APAs (P = .0112; ρ = 0.7237), in contrast, significantly inverse correlation was detected in ATP1A1-mutated APAs (P = .0025; ρ = -0.8667). CONCLUSION KCNJ5-mutated APAs, coexpressing CYP11B2 and CYP17A1, were more deviated in terms of zonation-specific differentiation of adrenocortical cells than ATP1A1- and ATP2B3-mutated APAs.
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Affiliation(s)
- Yoshikiyo Ono
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Departments of Molecular and Integrative Physiology & Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Omata
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tobias Else
- Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Scott A Tomlins
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
- Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan
| | - Yara Rhayem
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tracy Ann Williams
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tobias Carling
- Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, Connecticut
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zurich, Switzerland
| | - Sadayoshi Ito
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
| | - Fumitoshi Satoh
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - William E Rainey
- Departments of Molecular and Integrative Physiology & Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Correspondence and Reprint Requests: Hironobu Sasano, MD, PhD, Department of Pathology, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980- 8575 JAPAN. E-mail:
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41
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Hattangady NG, Foster J, Lerario AM, Ponce-Balbuena D, Rege J, Monticone S, Rainey WE, Mulatero P, Else T. Molecular and Electrophysiological Analyses of ATP2B4 Gene Variants in Bilateral Adrenal Hyperaldosteronism. Discov Oncol 2020; 11:52-62. [PMID: 32002807 DOI: 10.1007/s12672-019-00375-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/26/2019] [Indexed: 12/31/2022] Open
Abstract
Primary aldosteronism (PA) is the most common cause of secondary hypertension with a high prevalence among patients with resistant hypertension. Despite the recent discovery of somatic variants in aldosterone-producing adenoma (APA)-associated PA, causes for PA due to bilateral aldosterone production (bilateral hyperaldosteronism; BHA) remain unknown. Herein, we identified rare gene variants in ATP2B4, in a cohort of patients with BHA. ATP2B4 belongs to the same family of Ca-ATPases as ATP2B3, which is involved in the pathogenesis of APA. Endogenous ATP2B4 expression was characterized in adrenal tissue, and the gene variants were functionally analyzed for effects on aldosterone synthase (CYP11B2) expression, steroid production in basal and agonist-stimulated conditions, and for changes in biophysical properties of channel properties. Knockdown of ATP2B4 in HAC15 exhibited reduced angiotensin II stimulation in one of four shRNA clones. Stable HAC15 cell lines with doxycycline (dox) - inducible wild-type and variant forms of ATP2B4 - were generated, and dox-induced upregulation of ATP2B4 mRNA and protein was confirmed. However, ATP2B4 variants did not alter basal or agonist-stimulated CYP11B2 expression. Whole-cell recordings in HAC15 cells indicated robust endogenous ATP2B4 conductance in native cells but reduced conductance with overexpressed WT and variant ATP2B4. The previously defined PA-causing ATP2B3 variant served as a positive control and exhibited elevated CYP11B2 mRNA. In conclusion, while this study did not confirm a pathogenic role for ATP2B4 variants in BHA, we describe the sequencing analysis for familial and sporadic BHA and outline a template for the thorough in vitro characterization of gene variants.
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Affiliation(s)
- Namita Ganesh Hattangady
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI, 48109, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jessica Foster
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Antonio Marcondes Lerario
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI, 48109, USA
| | | | - Juilee Rege
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Silvia Monticone
- Department of Medical Sciences, Division of Internal Medicine and Hypertension, University of Torino, Via Genova 3, 10126, Torino, Italy
| | - William E Rainey
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI, 48109, USA.,Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Paolo Mulatero
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Tobias Else
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI, 48109, USA.
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42
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Burrello J, Buffolo F, Domenig O, Tetti M, Pecori A, Monticone S, Poglitsch M, Mulatero P. Renin-Angiotensin-Aldosterone System Triple-A Analysis for the Screening of Primary Aldosteronism. Hypertension 2020; 75:163-172. [DOI: 10.1161/hypertensionaha.119.13772] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary aldosteronism is recognized as the most frequent cause of secondary hypertension, and its screening is expected to become a routine evaluation in most patients with hypertension. The interference of antihypertensive therapies with the aldosterone-to-renin ratio during screening process is a major confounder. Renin-angiotensin-aldosterone system Triple-A analysis is a novel liquid chromatography/tandem mass spectrometry diagnostic assay that allows simultaneous quantification of aldosterone, equilibrium Ang I (angiotensin I), and Equilibrium Ang II in a single sample of serum. We performed a comparative evaluation of the diagnostic performance of the aldosterone-to-Ang II ratio and 5 renin-based diagnostic ratios, differing in methods to determine aldosterone levels and renin activity in a cohort of 110 patients with hypertension (33 patients with confirmed primary aldosteronism and 77 with essential hypertension). All ratios showed comparable areas under the curves ranging between 0.924 and 0.970 without significant differences between each other. The evaluation of the Ang II-to-Ang I ratio revealed persistent drug intake in some patients as cause for suppressed renin-based diagnostic ratios, while aldosterone-to-Ang II ratio remained unaffected. The Youden index optimal cutoff value for the aldosterone-to-Ang II ratio was 6.6 ([pmol/L]/[pmol/L]) with a sensitivity of 90% and a specificity of 93%, proving noninferiority compared with the aldosterone-to-renin ratio while pointing to the potential for an interference-free application in patients under ACE (angiotensin-converting enzyme) inhibitor therapy. This study shows for the first time the accuracy and reliability of renin-angiotensin-aldosterone system triple-A analysis for the screening of primary aldosteronism that can be applied in clinical routine.
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Affiliation(s)
- Jacopo Burrello
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (J.B., F.B., M.T., A.P., S.M., P.M.)
| | - Fabrizio Buffolo
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (J.B., F.B., M.T., A.P., S.M., P.M.)
| | | | - Martina Tetti
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (J.B., F.B., M.T., A.P., S.M., P.M.)
| | - Alessio Pecori
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (J.B., F.B., M.T., A.P., S.M., P.M.)
| | - Silvia Monticone
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (J.B., F.B., M.T., A.P., S.M., P.M.)
| | | | - Paolo Mulatero
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (J.B., F.B., M.T., A.P., S.M., P.M.)
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43
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Buffolo F, Li Q, Monticone S, Heinrich DA, Mattei A, Pieroni J, Mei M, Yang S, Hu YH, Yang MC, Sabbadin C, Pizzolo F, Giacchetti G, Fallo F, Veglio F, Reincke M, Wu VC, Mulatero P. Primary Aldosteronism and Obstructive Sleep Apnea: A Cross-Sectional Multi-Ethnic Study. Hypertension 2019; 74:1532-1540. [PMID: 31679423 DOI: 10.1161/hypertensionaha.119.13833] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association between primary aldosteronism (PA) and obstructive sleep apnea (OSA) has been a matter of debate. 2016 Endocrine Society guideline recommends screening for PA all hypertensive patients with OSA. We designed a multicenter, multiethnic, cross-sectional study to evaluate the prevalence of PA in patients with OSA and the prevalence of OSA in unselected patients with PA. Two hundred and three patients with OSA (102 whites and 101 Chinese) were screened for PA, and 207 patients with PA (104 whites, 100 Chinese, and 3 of African descent) were screened for OSA by cardiorespiratory polygraphy. Eighteen patients with OSA (8.9%) had PA (11.8% of white and 5.9% of Chinese ethnicity). In patients without other indications for PA screening, the prevalence of PA dropped to 1.5%. The prevalence of OSA in patients with PA was 67.6%, consistent in both white and Chinese patients. A correlation between aldosterone levels and apnea/hypopnea index was observed in white patients with PA (R2=0.225, P=0.016) but not in Chinese patients. Multinomial logistic regression confirmed a significant and independent association between plasma aldosterone levels and moderate to severe OSA diagnosis in white patients (odds ratio, 1.002; P=0.002). In conclusion, aldosterone levels may contribute to the severity of OSA in white patients with hyperaldosteronism, but patients with OSA are not at high risk of PA. Results of the present study challenge the current recommendation of the Endocrine Society guideline that all patients with OSA should be screened for PA, irrespective of the grade of hypertension.
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Affiliation(s)
- Fabrizio Buffolo
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., S.M., J.P., F.V., P.M.)
| | - Qifu Li
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., S.M., J.P., F.V., P.M.).,Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, China (Q.L., M.M., S.Y.)
| | | | - Daniel A Heinrich
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany (D.A.H., M.R.)
| | - Alessio Mattei
- Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy (A.M.)
| | - Jacopo Pieroni
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., S.M., J.P., F.V., P.M.)
| | - Mei Mei
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, China (Q.L., M.M., S.Y.)
| | - Shumin Yang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, China (Q.L., M.M., S.Y.)
| | - Ya-Hui Hu
- Division of Endocrine and Metabolism (Y.-H.H.), Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary Medicine (M.C.Y.), Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taiwan
| | - Chiara Sabbadin
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Italy (C.B., F.F.)
| | - Francesca Pizzolo
- Department of Medicine, Unit of Internal Medicine, University of Verona, Italy (F.P.)
| | - Gilberta Giacchetti
- Division of Endocrinology, Polytechnic University of Marche, Ancona, Italy (G.G.)
| | - Francesco Fallo
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Italy (C.B., F.F.)
| | - Franco Veglio
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., S.M., J.P., F.V., P.M.)
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany (D.A.H., M.R.)
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei (V.C.W.)
| | - Paolo Mulatero
- From the Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Italy (F.B., S.M., J.P., F.V., P.M.)
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44
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Burrello J, Gai C, Tetti M, Lopatina T, Deregibus MC, Veglio F, Mulatero P, Camussi G, Monticone S. Characterization and Gene Expression Analysis of Serum-Derived Extracellular Vesicles in Primary Aldosteronism. Hypertension 2019; 74:359-367. [DOI: 10.1161/hypertensionaha.119.12944] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients affected by primary aldosteronism (PA) display an increased risk of cardiovascular events compared with essential hypertension (EH). Endothelial dysfunction favors initiation and progression of atherosclerosis and circulating extracellular vesicles (EVs), reflecting endothelial cell activity, could represent one of the mediators of endothelial dysfunction in these patients. The aim of this study was to characterize circulating EVs from patients diagnosed with PA and to explore their functional significance. Serum EVs were isolated from 12 patients with PA and 12 with EH, matched by sex, age, and blood pressure, and compared with 8 normotensive controls. At nanoparticle tracking analysis, EVs concentration was 2.2× higher in patients with PA (
P
=0.033) compared with EH and a significant correlation between EV number and serum aldosterone and potassium levels was identified. Fluorescence-activated cell sorting analysis demonstrated that patients with PA presented a higher absolute number of endothelial-derived EVs compared with both patients with EH and normotensive controls. Through EV mRNA profiling, 15 up-regulated and 4 down-regulated genes in patients with PA compared with EH were identified; moreover,
EDN1
was expressed only in patients with PA. Microarray platform was validated by quantative real-time polymerase chain reaction on 4 genes (
CASP1
,
EDN1
,
F2R
, and
HMOX1
) involved in apoptosis, inflammation, and endothelial dysfunction. After unilateral adrenalectomy, EVs number and expression of
CASP1
and
EDN1
significantly decreased in patients with PA (
P
<0.05). Additionally, the incubation with PA-derived EVs reduced angiogenesis and induced apoptosis in vitro. Circulating EVs might not only represent a marker of endothelial dysfunction but also contribute themselves to vascular dysfunction in patients with PA.
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Affiliation(s)
- Jacopo Burrello
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (J.B., M.T., F.V., P.M., S.M.), University of Turin, Italy
| | - Chiara Gai
- Molecular Biotechnology Center (C.G., T.L., M.C.D., G.C.), University of Turin, Italy
| | - Martina Tetti
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (J.B., M.T., F.V., P.M., S.M.), University of Turin, Italy
| | - Tatiana Lopatina
- Molecular Biotechnology Center (C.G., T.L., M.C.D., G.C.), University of Turin, Italy
| | | | - Franco Veglio
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (J.B., M.T., F.V., P.M., S.M.), University of Turin, Italy
| | - Paolo Mulatero
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (J.B., M.T., F.V., P.M., S.M.), University of Turin, Italy
| | - Giovanni Camussi
- Molecular Biotechnology Center (C.G., T.L., M.C.D., G.C.), University of Turin, Italy
| | - Silvia Monticone
- From the Division of Internal Medicine 4 and Hypertension Unit, Department of Medical Sciences (J.B., M.T., F.V., P.M., S.M.), University of Turin, Italy
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45
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Pappaccogli M, Di Monaco S, Perlo E, Burrello J, D’Ascenzo F, Veglio F, Monticone S, Rabbia F. Comparison of Automated Office Blood Pressure With Office and Out-Off-Office Measurement Techniques. Hypertension 2019; 73:481-490. [DOI: 10.1161/hypertensionaha.118.12079] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Marco Pappaccogli
- From the Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences (M.P., S.D.M., E.P., J.B., S.M., F.R., F.V.), University of Turin, Italy
| | - Silvia Di Monaco
- From the Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences (M.P., S.D.M., E.P., J.B., S.M., F.R., F.V.), University of Turin, Italy
| | - Elisa Perlo
- From the Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences (M.P., S.D.M., E.P., J.B., S.M., F.R., F.V.), University of Turin, Italy
| | - Jacopo Burrello
- From the Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences (M.P., S.D.M., E.P., J.B., S.M., F.R., F.V.), University of Turin, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences (F.D.), University of Turin, Italy
| | - Franco Veglio
- From the Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences (M.P., S.D.M., E.P., J.B., S.M., F.R., F.V.), University of Turin, Italy
| | - Silvia Monticone
- From the Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences (M.P., S.D.M., E.P., J.B., S.M., F.R., F.V.), University of Turin, Italy
| | - Franco Rabbia
- From the Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences (M.P., S.D.M., E.P., J.B., S.M., F.R., F.V.), University of Turin, Italy
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46
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Monticone S, Losano I, Tetti M, Buffolo F, Veglio F, Mulatero P. Diagnostic approach to low-renin hypertension. Clin Endocrinol (Oxf) 2018; 89:385-396. [PMID: 29758100 DOI: 10.1111/cen.13741] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/25/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
Renin-angiotensin-aldosterone system (RAAS) plays a crucial role in maintaining water and electrolytes homoeostasis, and its deregulation contributes to the development of arterial hypertension. Since the historical description of the "classical" RAAS, a dramatic increase in our understanding of the molecular mechanisms underlying the development of both essential and secondary hypertension has occurred. Approximatively 25% of the patients affected by arterial hypertension display low-renin levels, a definition that is largely arbitrary and depends on the investigated population and the specific characteristics of the assay. Most often, low-renin levels are expression of a physiological response to sodium-volume overload, but also a significant number of secondary hereditary or acquired conditions falls within this category. In a context of suppressed renin status, the concomitant examination of plasma aldosterone levels (which can be inappropriately elevated, within the normal range or suppressed) and plasma potassium are essential to formulate a differential diagnosis. To distinguish between the different forms of low-renin hypertension is of fundamental importance to address the patient to the proper clinical management, as each subtype requires a specific and targeted therapy. The present review will discuss the differential diagnosis of the most common medical conditions manifesting with a clinical phenotype of low-renin hypertension, enlightening the novelties in genetics of the familial forms.
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Affiliation(s)
- Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Isabel Losano
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Martina Tetti
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Fabrizio Buffolo
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy
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47
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Hattangady NG, Lerario AM, Ponce-Balbuena D, Monticone S, Mulatero P, Else T. Abstract 233: Molecular and Electrophysiological Analyses of Gene Variants in Bilateral Adrenal Hyperaldosteronism. Circ Res 2018. [DOI: 10.1161/res.123.suppl_1.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary aldosteronism (PA) is the most common cause of secondary hypertension with a high prevalence amongst patients with resistant hypertension. Recently somatic mutations have been defined in aldosterone-producing adenomas (APAs)-associated PA. Herein, we analyzed a single hereditary case and in 30 sporadic cases of bilateral adrenal hyperaldoteronism (BHA) using whole exome sequencing and generated a candidate gene list using an allelic frequency ≤1%. Unique variants were identified in the gene
ATP2B4
[coding for a Ca-ATPase Pump, PMCA4], in the affected individuals in the familial case and in two sporadic BHA samples. These variants were chosen for
in vitro
analyses due the potential role on PMCA4 in regulating intracellular calcium and due to the causal role of mutations in the family member
ATP2B3
in APA-related PA. The
ATP2B4
variants were functionally analyzed testing the hypothesis that it causes an inability to pump out intracellular Ca
2+
, causing elevated intracellular Ca
2+
, net cell depolarization and increased aldosterone synthase (
CYP11B2
) expression. Results from
in vitro
molecular analyses: 1) Real time quantitative PCR (qPCR) confirmed
ATP2B4
mRNA in the various tissue including the human adult adrenal gland, APAs, and the human adrenocortical cell line HAC15. 2) Immunohistochemistry indicated PMCA4 expression throughout the adrenal cortex. 3) Knock down of
ATP2B4
in HAC15 exhibited reduced Angiotensin II-stimulation in one of four shRNA clones. 4) Stable HAC15 cell lines for doxycycline (dox) - inducible wildtype and variant forms of
ATP2B4
, were generated. Q-PCR and immunostaining confirmed dox-induced upregulation of ATP2B4 mRNA and protein. However, upregulation of the PMCA4 variants did not have a differential effect on basal or agonist-stimulated
CYP11B2
expression. Whole cell recordings in HAC15 and HEK cells indicated robust PMCA4 conductance in native cells, but reduced conductance in the WT and variant PMCA4. In conclusion, while this study did not define a pathogenic role for
ATP2B4
variants in BHA, we describe an approach of WES analysis for familial and sporadic BHA and outline a template for the thorough
in vitro
characterization of gene variants in the pathogenesis of BHA.
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Burrello J, Erhardt EM, Saint-Hilary G, Veglio F, Rabbia F, Mulatero P, Monticone S, D'Ascenzo F. Pharmacological Treatment of Arterial Hypertension in Children and Adolescents: A Network Meta-Analysis. Hypertension 2018; 72:306-313. [PMID: 29967035 DOI: 10.1161/hypertensionaha.118.10862] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/02/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022]
Abstract
Pharmacological treatment is indicated in children and adolescents with hypertension unresponsive to lifestyle modifications, but there is not enough evidence to recommend 1 class of antihypertensive drugs over others. We performed a network meta-analysis to compare the results of available randomized clinical trials on pharmacological treatment of pediatric hypertension. From a total of 554 potentially relevant studies, 13 randomized placebo-controlled clinical trials enrolling ≥50 patients and a follow-up ≥4 weeks were included. The reduction of systolic blood pressure (SBP) and diastolic BP (DBP) after treatment were the coprimary end points. A total of 2378 pediatric patients, with a median age of 12 years, were included in the analysis. After a median follow-up of 35 days, lisinopril and enalapril were found to be superior to placebo in reducing SBP and DBP, whereas only for DBP, losartan was found to be superior to placebo and lisinopril and enalapril were found to be superior to eplerenone. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were associated with a greater SBP and DBP reduction compared with placebo, likewise the mineralocorticoid receptor antagonist was inferior to angiotensin-converting enzyme inhibitors in DBP reduction. The analysis was adjusted for study-level mean age, percentage of women, mean baseline blood pressure, and mean weight, only the latter significantly affected DBP reduction. According to the present analysis, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers could represent the best choice as antihypertensive treatment for pediatric hypertension. However, because of the paucity of available data for the other classes of antihypertensive drugs, definitive conclusions are not allowed and further randomized controlled trials are warranted.
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Affiliation(s)
- Jacopo Burrello
- From the Division of Internal Medicine and Hypertension (J.B., F.V., F.R., P.M., S.M.)
| | - Elvira M Erhardt
- Department of Medical Sciences, University of Turin, Italy; and Department of Mathematical Sciences G. L. Lagrange, Polytechnic University of Turin, Italy (E.M.E., G.S.H.)
| | - Gaelle Saint-Hilary
- Department of Medical Sciences, University of Turin, Italy; and Department of Mathematical Sciences G. L. Lagrange, Polytechnic University of Turin, Italy (E.M.E., G.S.H.)
| | - Franco Veglio
- From the Division of Internal Medicine and Hypertension (J.B., F.V., F.R., P.M., S.M.)
| | - Franco Rabbia
- From the Division of Internal Medicine and Hypertension (J.B., F.V., F.R., P.M., S.M.)
| | - Paolo Mulatero
- From the Division of Internal Medicine and Hypertension (J.B., F.V., F.R., P.M., S.M.)
| | - Silvia Monticone
- From the Division of Internal Medicine and Hypertension (J.B., F.V., F.R., P.M., S.M.)
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Tetti M, Castellano I, Venziano F, Magnino C, Veglio F, Mulatero P, Monticone S. Role of Cryptochrome-1 and Cryptochrome-2 in Aldosterone-Producing Adenomas and Adrenocortical Cells. Int J Mol Sci 2018; 19:ijms19061675. [PMID: 29874863 PMCID: PMC6032245 DOI: 10.3390/ijms19061675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 11/17/2022] Open
Abstract
Mice lacking the core-clock components, cryptochrome-1 (CRY1) and cryptochrome-2 (CRY2) display a phenotype of hyperaldosteronism, due to the upregulation of type VI 3β-hydroxyl-steroid dehydrogenase (Hsd3b6), the murine counterpart to the human type I 3β-hydroxyl-steroid dehydrogenase (HSD3B1) gene. In the present study, we evaluated the role of CRY1 and CRY2 genes, and their potential interplay with HSD3B isoforms in adrenal pathophysiology in man. Forty-six sporadic aldosterone-producing adenomas (APAs) and 20 paired adrenal samples were included, with the human adrenocortical cells HAC15 used as the in vitro model. In our cohort of sporadic APAs, CRY1 expression was 1.7-fold [0.75–2.26] higher (p = 0.016), while CRY2 showed a 20% lower expression [0.80, 0.52–1.08] (p = 0.04) in APAs when compared with the corresponding adjacent adrenal cortex. Type II 3β-hydroxyl-steroid dehydrogenase (HSD3B2) was 317-fold [200–573] more expressed than HSD3B1, and is the main HSD3B isoform in APAs. Both dehydrogenases were more expressed in APAs when compared with the adjacent cortex (5.7-fold and 3.5-fold, respectively, p < 0.001 and p = 0.001) and HSD3B1 was significantly more expressed in APAs composed mainly of zona glomerulosa-like cells. Treatment with angiotensin II (AngII) resulted in a significant upregulation of CRY1 (1.7 ± 0.25-fold, p < 0.001) at 6 h, and downregulation of CRY2 at 12 h (0.6 ± 0.1-fold, p < 0.001), through activation of the AngII type 1 receptor. Independent silencing of CRY1 and CRY2 genes in HAC15 cells resulted in a mild upregulation of HSD3B2 without affecting HSD3B1 expression. In conclusion, our results support the hypothesis that CRY1 and CRY2, being AngII-regulated genes, and showing a differential expression in APAs when compared with the adjacent adrenal cortex, might be involved in adrenal cell function, and in the regulation of aldosterone production.
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Affiliation(s)
- Martina Tetti
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, 10126 Torino, Italy.
| | - Isabella Castellano
- Division of Pathology, Department of Medical Sciences, University of Torino,10126 Torino, Italy.
| | - Francesca Venziano
- Division of Pathology, Department of Medical Sciences, University of Torino,10126 Torino, Italy.
| | - Corrado Magnino
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, 10126 Torino, Italy.
| | - Franco Veglio
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, 10126 Torino, Italy.
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, 10126 Torino, Italy.
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, 10126 Torino, Italy.
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Abstract
PURPOSE OF REVIEW The aim of the present manuscript is to provide an overview of the most updated studies on the prevalence of primary aldosteronism in primary care and to compare these figures with the actual rate of diagnosis in clinical practice and with the prevalence of primary aldosteronism in specific subgroup of patients. RECENT FINDINGS Over the last 20 years the clinical spectrum of low renin hypertension and primary aldosteronism has changed dramatically. Once considered only in the presence of severe hypertension and hypokalemia, it is now well known that primary aldosteronism is not uncommon even in patients with mild forms of hypertension and/or normokalemia. Moreover, recent evidence points toward a large proportion of normotensive study participants as being affected by subclinical primary aldosteronism, which represents a strong risk factor for incident hypertension. Moreover, primary aldosteronism patients are exposed to an increased risk of cardio and cerebrovascular events and metabolic comorbidities compared with patients affected by essential hypertension. Disappointingly, primary aldosteronism remains a largely underdiagnosed and undertreated disorder. SUMMARY These recent findings further highlight the importance of widening the spectrum of patients who should be screened for primary aldosteronism, to reduce the cardiovascular risk associated with this medical condition.
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Affiliation(s)
- Fabrizio Buffolo
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Turin, Italy
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