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  • 1
    Publication Date: 2016-04-14
    Description: Adrenal venous sampling is considered to be the most reliable diagnostic procedure to lateralize aldosterone excess in primary aldosteronism (PA). However, normative criteria have not been established partially because of a lack of data in non-PA hypertensive patients. The aim of the study was to investigate aldosterone concentration and its gradient in the adrenal vein of non-PA hypertensive patients. We retrospectively studied the results of cosyntropin-stimulated adrenal venous sampling in 40 hypertensive patients who showed positive screening testing but negative results in 2 confirmatory tests/captopril challenge test and saline infusion test. Plasma aldosterone concentration, aldosterone/cortisol ratio, its higher/lower ratio (lateralization index) in the adrenal vein with cosyntropin stimulation were measured. Median plasma aldosterone concentration in the adrenal vein was 25 819 pg/mL (range, 5154–69 920) in the higher side and 12 953 (range, 1866–36 190) pg/mL in the lower side ( P 〈0.001). There was a significant gradient in aldosterone/cortisol ratio between the higher and the lower sides (27.2 [5.4–66.0] versus 17.3 [4.0–59.0] pg/mL per μg/dL; P 〈0.001) with lateralization index ranging from 1.01 to 3.87. The aldosterone lateralization gradient was between 1 to 2 in 32 patients and 2 to 4 in 8 patients. None of the patients showed lateralization index ≥4. The present study demonstrated that plasma aldosterone concentration in the adrenal veins showed significant variation and lateralization gradient even in non-PA hypertensive patients. Adrenal venous sampling aldosterone lateralization gradients between 2 and 4 should be interpreted with caution in patients with PA because these gradients can be found even in patients with negative confirmatory testing for PA.
    Keywords: ACE/Angiotensin Receptors/Renin Angiotensin System, Hypertension
    Print ISSN: 0194-911X
    Topics: Medicine
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  • 2
    Publication Date: 2012-08-16
    Description: Objective— Cardiovascular diseases are associated with impaired flow-mediated vasodilation (FMD) and increase in carotid intima-media thickness (IMT). Both FMD and IMT are independent predictors for cardiovascular outcomes. When measuring FMD and nitroglycerine-induced vasodilation in the brachial artery, IMT can also be simultaneously assessed in the same brachial artery. The purpose of this study was to determine the relationships between IMT of the brachial artery, vascular function, and cardiovascular risk factors. Methods and Results— We measured brachial IMT, FMD, and nitroglycerine-induced vasodilation by ultrasound in 388 subjects who underwent health examination (mean age, 45±22 years; age range, 19–86), including patients with cardiovascular diseases. Univariate regression analysis revealed that brachial IMT significantly correlated with age ( r =0.71; P 〈0.001), body mass index ( r =0.27; P 〈0.001), systolic blood pressure ( r =0.40; P 〈0.001), diastolic blood pressure ( r =0.31; P 〈0.001), heart rate ( r =0.15; P =0.002), glucose level ( r =0.18; P =0.01), and smoking pack-years ( r =0.42; P 〈0.001), as well as Framingham risk score, a cumulative cardiovascular risk index for heart attack ( r =0.49; P 〈0.001). FMD and nitroglycerine-induced vasodilation were inversely associated with brachial IMT ( r =–0.39, P 〈0.001; r =–0.32, P 〈0.001, respectively). In addition, there was a significant relationship between brachial IMT and carotid IMT ( r =0.58; P 〈0.001). Multivariate analysis revealed that age, sex, hypertension, and brachial artery diameter were independent predictors of brachial IMT. Conclusion— These findings suggest that brachial IMT may be a marker of the grade of atherosclerosis and may be used as a marker of vascular function, providing additive information for stratifying subjects with cardiovascular risk factors.
    Keywords: Risk Factors
    Print ISSN: 1079-5642
    Electronic ISSN: 1524-4636
    Topics: Medicine
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