Dott. Mirko Parasiliti Caprino
- Dottorato in Fisiopatologia Medica
- Dottorato: 29° ciclo
- Matricola: 283810
- ORCID: orcid.org/0000-0002-6930-7073
Tesi di dottorato
Title: "Prevalence of Primary Aldosteronism, association with Metabolic Syndrome and vascular damage in a population of resistant hypertensives".
Objective. To estimate the prevalence of primary aldosteronism (PA) among subjects with resistant hypertension (RH - insufficient pressure control despite treatment with three full dose drugs, including a diuretic) and its association with subclinical vascular damage.
Design. Observational, cross-sectional study.
Methods. 77 consecutive resistant hypertensive subjects without previous cardiovascular events, sent to a Tertiary referral Center for Hypertension, were recruited after excluding the presence of other causes of secondary hypertension than PA. Demographic and metabolic variables were registered and vascular damage (micro/macro albuminuria and carotid intima-media thickness) researched. The patients were considered affected by PA when the following conditions were discovered: plasma aldosterone concentration (PAC) > 200 pg/mL, PRA < 1 ng/mL/h, aldosterone to renin ratio (ARR) > 400, plasma aldosterone concentration after NaCl test > 100 pg/mL. In a subgroup of patients, we performed a modified oral glucose tolerance test (OGTT) to evaluate Insulin Sensitivity. We collected this datas in blind with the final diagnosis of PA or Essential Hypertension (EH).
Results. PA was diagnosed in 22/77 subjects (28.6%); the remaining 55 were classified as EH. PA was associated to high levels of albuminuria (OR=10.5, CI 1.5-74.0; p = 0.018), increased IMT > 0.9 mm (OR=11.8, CI 1.5-93.7; p = 0.020) and vascular damage (presence of microalbuminuria and/or increased IMT, OR=11.8, CI 1.5-93.7). Metabolic Syndrome wasn't associated with PA and no statistical significance was found in differences of Insulin Sensitivity indexes in the two groups.
Conclusions. PA is a common condition in RH. Patients with PA have higher rate of subclinical organ damage than subjects with EH. This study suggests a central role of aldosterone in the pathogenesis of both resistance to the pharmacological treatment for hypertension and cardiovascular damage. We didn't find any significative results on the association of PA and metabolic complications.
Attività di ricerca
"Cardiometabolic complications in primary aldosteronism". Coordinator: Prof. Mauro Maccario (University of Turin)
"Clinical impact of Idiopathic Primary Aldosteronism". Coordinator: Prof. Mauro Maccario (University of Turin)
“Circulating microRNA in primary Aldosteronism”. Coordinator: Prof. Peter Igaz (University of Budapest) for ENSAT
“Prevalence of associated tumors in patients with non-syndromic pheochromocytoma / paraganglioma”. Coordinators: Prof. Massimo Terzolo, Prof. Massimo Mannelli (University of Turin – University of Florence) for SIE
“Genetic basis of primary aldosteronism”. Coordinator: Prof. Paolo Mulatero (University of Turin)
"Natural history and genetic basis of pheochromocytoma and paraganglioma". Coordinators: Prof. Mauro Maccario, Prof.ssa Emanuela Arvat, Prof.ssa Barbara Pasini (University of Turin)
“Management of neuroendocrine tumors and renal cancers in VHL syndrome”. Cordinators: Prof. Mauro Maccario, Prof.ssa Barbara Pasini, Dr. Claudio De Angelis (University of Turin)
"Timing of meals and variation of diet induced thermogenesis (DIT), metabolic and hormonal parameters". Coordinator: Prof.ssa Simona Bo (University of Turin)
Impact of SGLT-2 inhibitors therapy on antidiuretic function and renin-angiotensin-aldosterone system. Coordinators: Prof. Ezio Ghigo, Prof. Mauro Maccario, Dr.ssa Silvia Grottoli (University of Turin)
“Analysis of steroids and amines in tandem mass spectrometry”. Coordinators: Dr. Giulio Mengozzi, Dr. Fabio Settanni (University of Turin)
Fellow - Endocrinology and Metabolism Disease, University of Turin
Tutor of Evidence Based Medicine (Coordinator: Prof. Franco Merletti) – School of Medicine, University of Turin
Tutor of Nursing Master in Endocrinology and Metabolism, University of Turin
Senior tutor of Endocrinology for the Italian Academy of Medical Fellows (AIMS)