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Copeptin is increased in resistant hypertension.

Margarida Mendes1, Julie Dubourg, Anne Blanchard

  • 1aServiço de Saúde da Região Autónoma da Madeira, Dr Rui Adriano de Freitas Health Centre, Funchal, Madeira, Portugal bAssistance Publique Hôpitaux de Paris, Centre d'Investigation Clinique, Hôpital Européen Georges Pompidou cUniversité Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité dINSERM, CIC 1418 eAssistance Publique Hôpitaux de Paris, département de génétique fAssistance Publique Hôpitaux de Paris, Unité d'Hypertension Artérielle, Hôpital Européen Georges Pompidou, Paris, France.

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PubMed
Summary

Resistant hypertension patients show higher plasma copeptin levels, a marker for vasopressin secretion, compared to controlled blood pressure patients. This suggests a primary osmostat reset in resistant hypertension.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiovascular Medicine

Background:

  • Vasopressin's role in resistant hypertension is not fully understood.
  • Copeptin serves as a reliable surrogate marker for vasopressin secretion.

Purpose of the Study:

  • To compare plasma copeptin concentrations between patients with resistant hypertension and those with controlled blood pressure (CBP).
  • To investigate the association of copeptin with clinical parameters in resistant hypertension.

Main Methods:

  • A post hoc analysis of the Prise en charge de l'Hypertension Artérielle RESistante au traitement trial.
  • Plasma copeptin was measured using immunoassay in 166 patients (140 resistant hypertension, 26 CBP) at baseline and after 12 weeks of treatment.
  • Patients with resistant hypertension received sequential nephron blockade or sequential renin-angiotensin system blockade.

Main Results:

  • Baseline plasma copeptin was higher in resistant hypertension patients (5.7 fmol/ml) than in CBP patients (2.9 fmol/ml), P < 0.0001.
  • Higher copeptin levels were associated with male sex, higher plasma osmolality, and higher blood pressure.
  • Even after BP control, copeptin levels remained significantly elevated in previously resistant hypertension patients.

Conclusions:

  • Resistant hypertension is associated with approximately two-fold higher plasma copeptin concentrations, independent of renal resistance to vasopressin.
  • These findings suggest a primary osmostat reset in patients with resistant hypertension.
  • Vasopressin may play a significant role in the pathophysiology of resistant hypertension.