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[Absence of nocturnal decrease in blood pressure in 24-hour blood pressure monitoring: an indication of secondary
I Schrader1, C Person, U Pfertner
1Abteilung für Nephrologie und Rheumatologie, Medizinische Universitätsklinik Göttingen.
Insights
The absence of a normal nighttime blood pressure drop during 24-hour ambulatory monitoring may indicate secondary hypertension. This finding helps differentiate secondary hypertension from essential hypertension, aiding diagnosis.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Context:
- Secondary hypertension affects a significant patient population.
- Differentiating secondary from essential hypertension is crucial for effective treatment.
- Ambulatory blood pressure monitoring (ABPM) provides insights into circadian blood pressure patterns.
Purpose:
- To investigate the diagnostic value of circadian blood pressure patterns in identifying secondary hypertension.
- To compare 24-hour ambulatory blood pressure monitoring (ABPM) results between patients with secondary hypertension and essential hypertension.
- To assess the impact of treating underlying conditions on blood pressure circadian rhythms.
Summary:
- A study compared 81 patients with secondary hypertension (various causes) to 201 with essential hypertension using 24-hour ABPM.
- Essential hypertension typically shows a nightly blood pressure decline (≥15 mmHg), observed in 98.5% of patients.
- 69% of secondary hypertension patients exhibited an attenuated or absent nocturnal blood pressure dip, with pheochromocytoma, diabetic nephropathy, Conn's disease, and post-transplant patients showing the most significant deviations.
Impact:
- The absence of a nocturnal blood pressure decline during ABPM is a potential indicator of secondary hypertension.
- Restoration of circadian blood pressure rhythm post-treatment suggests the reversibility of hypertensive mechanisms.
- These findings can improve the diagnostic pathway for secondary hypertension, leading to more targeted therapies.
Abstract:
Non invasive 24 hours ambulatory blood pressure monitoring was performed in 81 patients with secondary hypertension (renoparenchymatous nephropathy n = 15, diabetic nephropathy n = 10, Conn's disease n = 4, renal artery stenosis n = 15, pheochromocytoma n = 2, hemodialysis patients n = 15 and patients after kidney transplantation n = 20). The results were compared to 201 patients with essential hypertension. The results showed that 98.5% of patients with essential hypertension have a nightly decline in blood pressure of at least 15 mmHg (systolic + diastolic), whereas 69% of patients with secondary hypertension showed either an attenuated circadian rhythm or no circadian rhythm. Patients with pheochromocytoma who had a night time increase in blood pressure demonstrated the greatest difference to the essential hypertension collective followed by patients with diabetic nephropathy, Conn's disease and the group of patients after kidney transplantation. After successful treatment of the condition leading to hypertension circadian periodicity returned in some patients. In summary these results suggest that the absence of a night time decline in blood pressure during 24-hour-ambulatory monitoring is an indication of secondary hypertension.