{"id":2157,"date":"2021-07-08T09:15:25","date_gmt":"2021-07-08T00:15:25","guid":{"rendered":"https:\/\/www.hcfm.jp\/journal\/?p=2157"},"modified":"2021-07-08T17:04:27","modified_gmt":"2021-07-08T08:04:27","slug":"testing-rates-in-patients-at-high-risk-for-primary-aldosteronism-march-2021","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2157","title":{"rendered":"Testing rates in patients at high risk for primary aldosteronism (March 2021)"},"content":{"rendered":"

\u203b\u3053\u306e\u6642\u671f\u306eUpToDate\u306b\u3042\u308b\u201dWhat\u2019s new in family medicine\u201d\u306eTopic\u3067\u53c2\u8003\u306b\u3055\u308c\u3066\u3044\u308b\u6587\u732e\u3067\u3059\u3002<\/p>\n

\u2015\u6587\u732e\u2015
\nCohen JB, Cohen DL, Herman DS, Leppert JT, Byrd JB, Bhalla V. Testing for Primary Aldosteronism and Mineralocorticoid Receptor Antagonist Use Among U.S. Veterans : A Retrospective Cohort Study. Ann Intern Med. 2021 Mar;174(3):289-297. doi: 10.7326\/M20-4873. Epub 2020 Dec 29. PMID: 33370170; PMCID: PMC7965294.<\/p>\n

\u2015\u8981\u7d04\u2015
\nIntroduction\uff1a
\n\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306f\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u306e\u4e00\u822c\u7684\u306a\u539f\u56e0\u3067\u3042\u308b\u3002\u3057\u304b\u3057\u30ab\u30ea\u30d5\u30a9\u30eb\u30cb\u30a2\u3001\u30a4\u30ea\u30ce\u30a4\u3001\u304a\u3088\u3073\u30cb\u30e5\u30fc\u30e8\u30fc\u30af\u306e\u30d8\u30eb\u30b9\u30b7\u30b9\u30c6\u30e0\u306e\u7814\u7a76\u304b\u3089\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u3067\u306f\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u691c\u67fb\u7387\u304c\u63a8\u5968\u3055\u308c\u3066\u3044\u308b\u60a3\u8005\u306e\u9593\u30673%\u672a\u6e80\u3068\u4f4e\u3044\u3053\u3068\u304c\u793a\u5506\u3055\u308c\u3066\u3044\u308b\u3002
\n\u3057\u304b\u3057\u3001\u540c\u69d8\u306e\u7814\u7a76\u306f\u5927\u898f\u6a21\u306b\u306f\u884c\u308f\u308c\u3066\u304a\u3089\u305a\u3001\u5927\u898f\u6a21\u3067\u9ad8\u5ea6\u306b\u7d71\u5408\u3055\u308c\u305f\u533b\u7642\u30b7\u30b9\u30c6\u30e0\u3067\u691c\u67fb\u7387\u304c\u4f4e\u3044\u304b\u3069\u3046\u304b\u306f\u4e0d\u660e\u3067\u3042\u308b\u3002\u660e\u3089\u304b\u306a\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u306e\u767a\u75c7\u3068\u691c\u67fb\u306b\u95a2\u9023\u3059\u308b\u8981\u56e0\u3092\u6709\u3059\u308b\u7c73\u56fd\u9000\u5f79\u8ecd\u4eba\u306b\u304a\u3051\u308b\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u691c\u67fb\u983b\u5ea6\u3092\u8a55\u4fa1\u3059\u308b\u3053\u3068\u3092\u76ee\u7684\u3068\u3057\u305f\u3002\u307e\u305f\u3001\u30c6\u30b9\u30c8\u304cMRA\u7642\u6cd5\u306b\u3088\u308b\u660e\u3089\u304b\u306a\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u306e\u30a8\u30d3\u30c7\u30f3\u30b9\u306b\u57fa\u3065\u304f\u6cbb\u7642\u53ca\u3073\u9577\u671f\u8840\u5727\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u306e\u9055\u3044\u3068\u95a2\u9023\u3057\u3066\u3044\u308b\u304b\u3069\u3046\u304b\u3092\u8a55\u4fa1\u3057\u3088\u3046\u3068\u3057\u305f\u3002
\nMethod\uff1a
\n\u3000Design:\u30ec\u30c8\u30ed\u30b9\u30da\u30af\u30c6\u30a3\u30d6\u30b3\u30db\u30fc\u30c8
\n\u3000Date Source:\u7c73\u56fd\u9000\u5f79\u8ecd\u4eba\u4fdd\u5065\u5c40(VHA) Corporate Date Warehouse\u306e\u7c73\u56fd\u9000\u5f79\u8ecd\u4eba\u4fdd\u5065\u5c40\u30c7\u30fc\u30bf\u3092\u4f7f\u7528\u3002\u3053\u306e\u30c7\u30fc\u30bf\u306b\u306f\u7d04900\u4e07\u4eba\u306e\u9000\u5f79\u8ecd\u4eba\u306b\u95a2\u3059\u308b\u8a73\u7d30\u306a\u8a3a\u65ad\u30b3\u30fc\u30c9\u3001\u691c\u67fb\u7d50\u679c\u3001\u30d0\u30a4\u30bf\u30eb\u30b5\u30a4\u30f3\u3001\u85ac\u5c40\u306e\u51e6\u65b9\u8a18\u9332\u304c\u542b\u307e\u308c\u308b\u3002
\n Participants
\n2000\u5e74\u301c2017\u5e74\u306b\u660e\u3089\u304b\u306a\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\uff08n=269,010\uff09\u306e\u9000\u5f79\u8ecd\u4eba\u3067\u3001\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u3068\u306f\uff13\u7a2e\u985e\u306e\u964d\u5727\u85ac\uff08\u5229\u5c3f\u85ac\u3092\u542b\u3080\uff09\u3067\u6cbb\u7642\u4e2d\u306b\u5c11\u306a\u304f\u3068\u30821\u30f6\u6708\u9593\u9694\u3067\u53ce\u7e2e\u671f\u8840\u5727\u304c140mmHg\u3082\u3057\u304f\u306f\u62e1\u5f35\u671f\u8840\u5727\u304c90mmHg\u4ee5\u4e0a\u3067\u3042\u308b\u3053\u3068\u3001\u3082\u3057\u304f\u306f\uff14\u3064\u306e\u30af\u30e9\u30b9\u306e\u964d\u5727\u85ac\u3092\u5fc5\u8981\u3068\u3059\u308b\u9ad8\u8840\u5727\u3067\u5b9a\u7fa9\u3055\u308c\u308b\u3002
\n\u3000\u9664\u5916\uff1a\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u691c\u67fb\u3092\u53d7\u3051\u305f\u3001\u307e\u305f\u306f\u660e\u3089\u304b\u306a\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u306e\u57fa\u6e96\u3092\u6e80\u305f\u3059\u524d\u306bMRA\u6cbb\u7642\u3092\u958b\u59cb\u3057\u305f\u60a3\u8005\u3001\u304a\u3088\u3073\u660e\u3089\u304b\u306a\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u306e\u57fa\u6e96\u3092\u6e80\u305f\u3059\u524d\u306b\u6162\u6027\u814e\u81d3\u75c5\u30b9\u30c6\u30fc\u30b8\uff14\u307e\u305f\u306f\uff15\u307e\u305f\u306f\u672b\u671f\u814e\u81d3\u75c5\u3092\u60a3\u3063\u305f\u60a3\u8005\u3092\u9664\u5916\u3057\u305f\u3002
\nprimary end point:\u8840\u4e2d\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u6fc3\u5ea6\u3068\u8840\u6f3f\u30ec\u30cb\u30f3\u6d3b\u6027\u307e\u3060\u306f\u8840\u6f3f\u30ec\u30cb\u30f3\u6fc3\u5ea6\u306e\u3044\u305a\u308c\u304b\u306e\u540c\u6642\u6e2c\u5b9a\u3068\u3057\u3066\u5b9a\u7fa9\u3055\u308c\u308b\u3001\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u691c\u67fb\u306e\u5b9f\u65bd\u5272\u5408
\nsecondary end point\uff1aMRA\u6cbb\u7642\u306e\u958b\u59cb\u3068SBP\u306e\u7d4c\u6642\u7684\u5909\u5316<\/p>\n

Results
\n\u660e\u3089\u304b\u306a\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u306e\u57fa\u6e96\u3092\u6e80\u305f\u3057\u305f\u5f8c\u306e\u3001\u30d5\u30a9\u30ed\u30fc\u671f\u9593\u306e\u4e2d\u592e\u5024\u306f3.3\u5e74\u3067\u30014277\u4eba\uff081.6%\uff09\u304c\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u691c\u67fb\u3092\u53d7\u3051\u305f\u3002(Figure1) Figure2\u306e\u5de6\u306e\u56f3\u306f\u5404VHA\u533b\u7642\u30bb\u30f3\u30bf\u30fc\uff08n=130\uff09\u3067\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u691c\u67fb\u3092\u53d7\u3051\u305f\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u75c7\u306e\u60a3\u8005\u306e\u5272\u5408\u3092\u793a\u3057\u3066\u3044\u308b\u3002\u691c\u67fb\u7387\u306f\u5168\u4f53\u306e0~6%\u3067\u660e\u3089\u304b\u306a\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u306e\u60a3\u8005\u6570\u306f\u533b\u7642\u30bb\u30f3\u30bf\u30fc\u5168\u4f53\u306e\u691c\u67fb\u7387\u3068\u306e\u76f8\u95a2\u306f\u306a\u304b\u3063\u305f\u3002Figure2\u306e\u53f3\u306e\u56f3\u306f\u5e74\u3054\u3068\u306e\u691c\u67fb\u7387\u3067\u691c\u67fb\u7387\u306f\u5e74\u9593\uff11\u301c\uff12\uff05\u3060\u3063\u305f\u3002
\n(Appendix Figure)\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u691c\u67fb\u306b\u95a2\u9023\u3059\u308b\u8981\u56e0\u3068\u3057\u3066\u3001\u60a3\u8005\u30ec\u30d9\u30eb\u3067\u306f\u4f4e\u30ab\u30ea\u30a6\u30e0\u8840\u75c7(standardized hazard ratio [HR], 1.93 [95% CI,1.80 to 2.07])\u3001\u3088\u308a\u9ad8\u3044SBP(standardized HR, 1.43 [CI,1.37 to 1.49])\u3001\u3092\u542b\u3080\u3044\u304f\u3064\u304b\u306e\u8981\u56e0\u304c\u691c\u67fb\u3092\u53d7\u3051\u308b\u53ef\u80fd\u6027\u304c\u9ad8\u3044\u3002\u307e\u305f\u3001\u814e\u81d3\u5185\u79d1\u533b(HR,2.05[95%CI,1.66~2.52])\u307e\u305f\u306f\u5185\u5206\u6ccc\u79d1\u533b(HR,2.48[95%CI,1.69~3.63])\u306b\u3088\u308b\u60a3\u8005\u306e\u554f\u984c\u3092\u7279\u5b9a\u3059\u308b\u305f\u3081\u306e\u5916\u6765(index visit)\u306f\u30d7\u30e9\u30a4\u30de\u30ea\u30b1\u30a2\u3068\u6bd4\u8f03\u3057\u3066\u691c\u67fb\u3092\u3059\u308b\u53ef\u80fd\u6027\u304c\u9ad8\u3044\u3053\u3068\u306b\u95a2\u9023\u3057\u3066\u3044\u305f\u3002\u30bb\u30f3\u30bf\u30fc\u30ec\u30d9\u30eb\u3067\u306f\u5730\u65b9\u306f\u975e\u5730\u65b9\u3088\u308a\u691c\u67fb\u3092\u3059\u308b\u53ef\u80fd\u6027\u304c\u4f4e\u304b\u3063\u305f(HR, 0.53 [CI, 0.31 to 0.91])\u3002
\n(table2)\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u691c\u67fb\u3092\u5b9f\u65bd\u3057\u305f\u5834\u5408\u306f\u691c\u67fb\u306a\u3057\u306e\u5834\u5408\u3068\u6bd4\u8f03\u3057\u3066\u3001MRA\u7642\u6cd5\u3092\u958b\u59cb\u3059\u308b\u53ef\u80fd\u6027\u304c4\u500d\u9ad8\u304f(HR 4.10[CI3.68~4.55])\u3001\u4f4e\u30ab\u30ea\u30a6\u30e0\u8840\u75c7\u306e\u75c5\u6b74\u306e\u3042\u308b\u60a3\u8005\u306f\u4f4e\u30ab\u30ea\u30a6\u30e0\u8840\u75c7\u306e\u306a\u3044\u60a3\u8005(HR, 4.21 [CI, 3.59 to 4.94])\u3088\u308aMRA(HR, 7.11 [CI, 6.25 to 8.10])\u3067\u6cbb\u7642\u3055\u308c\u308b\u53ef\u80fd\u6027\u306f\u9ad8\u304b\u3063\u305f\u3001\u305d\u3057\u3066\u3001\u6642\u9593\u7d4c\u904e\u3068\u3068\u3082\u306b\u3088\u308a\u826f\u3044\u8840\u5727\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u3068\u95a2\u9023\u3057\u3066\u3044\u305f\u3002
\n\u3000Limitation:\u4e3b\u306b\u7537\u6027\u306e\u30b3\u30db\u30fc\u30c8\u3067\u5f8c\u308d\u5411\u304d\u30c7\u30b6\u30a4\u30f3\u3001\u8aa4\u5206\u985e\u306b\u5bfe\u3059\u308b\u8a3a\u5bdf\u5ba4\u8840\u5727\u306e\u611f\u53d7\u6027\u306e\u554f\u984c\u3001\u304a\u3088\u3073\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u78ba\u5b9a\u691c\u67fb\u306e\u6b20\u5982\u306a\u3069\u304climitation\u3067\u3042\u308b\u3002
\n Conclusion\uff1a\u660e\u3089\u304b\u306a\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u3092\u4f34\u3046\u9000\u5f79\u8ecd\u4eba\u306b\u95a2\u3059\u308b\u5168\u56fd\u7684\u306b\u65bd\u884c\u3057\u305f\u30b3\u30db\u30fc\u30c8\u3067\u306f\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u691c\u67fb\u306f\u7a00\u3067\u3042\u308a\u3001\u539f\u767a\u6027\u30a2\u30eb\u30c9\u30b9\u30c6\u30ed\u30f3\u75c7\u306e\u691c\u67fb\u306fMRA\u306b\u3088\u308b\u30a8\u30d3\u30c7\u30f3\u30b9 \u306b\u57fa\u3065\u304f\u6cbb\u7642\u306e\u5272\u5408\u304c\u9ad8\u3044\u3053\u3068\u3068\u3001\u9577\u671f\u7684\u306aBP\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u304c\u512a\u308c\u3066\u3044\u308b\u3053\u3068\u306b\u95a2\u9023\u3057\u3066\u3044\u305f\u3002\u3053\u306e\u767a\u898b\u306f\u5c0f\u898f\u6a21\u306a\u533b\u7642\u30b7\u30b9\u30c6\u30e0\u306b\u304a\u3051\u308b\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u63a8\u5968\u306e\u5b9f\u8df5\u3078\u306e\u9075\u5b88\u304c\u4f4e\u3044\u3068\u3044\u3046\u4ee5\u524d\u306e\u89b3\u5bdf\u3092\u88dc\u5f37\u3057\u3001\u6cbb\u7642\u62b5\u6297\u6027\u9ad8\u8840\u5727\u60a3\u8005\u306e\u7ba1\u7406\u3092\u6539\u5584\u3059\u308b\u7dca\u6025\u306e\u5fc5\u8981\u6027\u3092\u5f37\u8abf\u3057\u3066\u3044\u308b\u3002<\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

\"\"<\/a><\/p>\n

\u3010\u958b\u50ac\u65e5\u3011
\n2021\u5e747\u67087\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

\u203b\u3053\u306e\u6642\u671f\u306eUpToDate\u306b\u3042\u308b\u201dWhat\u2019s new in family medicine\u201d\u306eTopic\u3067\u53c2\u8003\u306b\u3055\u308c\u3066\u3044\u308b\u6587\u732e\u3067\u3059\u3002 \u2015\u6587\u732e\u2015 Cohen JB, Cohen DL, Herman DS, Leppe … \u7d9a\u304d\u3092\u8aad\u3080 Testing rates in patients at high risk for primary aldosteronism (March 2021)<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33,17],"tags":[],"class_list":["post-2157","post","type-post","status-publish","format-standard","hentry","category-whats-new","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2157","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2157"}],"version-history":[{"count":4,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2157\/revisions"}],"predecessor-version":[{"id":2165,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2157\/revisions\/2165"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2157"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2157"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2157"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}