Diagnostic and Therapeutic Perspective Analysis of Two Cases of Hypertension Combined with Hypokalemia and Literature Review

doi:10.12114/j.issn.1007-9572.2018.00.134

Abstract

Abstract: Hypertension combined with hypokalemia （HCH） is frequently seen in clinical practice.Due to complex underlying causes of HCH and difficult diagnosis，early onset，refractory and single gene hereditary hypertension are easy to appear，so early diagnosis and treatment are of great significance to the survival prognosis of the patients.Therefore，early diagnosis and treatment are of great prognostic significance.We reported one case of primary aldosteronism and one case of Liddle syndrome （LS） manifested by HCH，in particular，detailedly introduced the results of imaging examination，drug diagnostic test and genetic testing，and analyzed the features of HCH and the diagnostic value of aldosterone-to-renin ratio，imaging examination and genetic testing based on the review of related studies，and concluded that spironolactone in combination with other drugs are effective for refractory hypertension（RH），especially RH combined with low rennin，but ineffective for LS；amiloride and amitine are first-choice drugs for LS.

Key words: Hypertension, Hypokalemia, Hyperaldosteronism, Liddle syndrome, Case reports

摘要： 高血压合并低钾血症在临床上很常见，因病因众多复杂，诊断较困难，易出现早发性、难治性及单基因遗传性高血压，因此早期诊治对患者生存预后有重要意义。为探讨高血压合并低钾血症的诊断思路，本文对分别诊断为原发性醛固酮增多症及Liddle综合征（LS）的2例高血压合并低钾血症患者的影像学检查、药物诊断性试验及相关基因检测进行介绍，并结合文献分析了高血压合并低钾血症的特点以及醛固酮与肾素比值、影像学检查、基因检测对诊断的重要性，发现螺内酯可与其他降压药物联合治疗顽固性高血压，低肾素水平时降压效果更明显，但对LS无效；阿米洛利、氨苯蝶啶是LS的首选治疗药物。

关键词: 高血压, 低钾血症, 醛固酮增多症, Liddle综合征, 病例报告

ZHANG Zijie,WANG Chuangchang,LI Rong. Diagnostic and Therapeutic Perspective Analysis of Two Cases of Hypertension Combined with Hypokalemia and Literature Review　[J]. Chinese General Practice, 2019, 22(2): 234-237. DOI: 10.12114/j.issn.1007-9572.2018.00.134.
张梓洁,王创畅,李荣. 高血压合并低钾血症两例报道及诊断思路分析[J]. 中国全科医学, 2019, 22(2): 234-237. DOI: 10.12114/j.issn.1007-9572.2018.00.134.

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