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Published on: August 1, 2018
Circadian hemodynamic characteristics in hypertensive patients with primary aldosteronism
Hiroshi Kusunoki1,2, Yoshio Iwashima1, Yuhei Kawano1,3
1Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Osaka.
Insights
Primary aldosteronism in hypertensive patients is linked to higher central blood pressure and altered daily variations in blood pressure and vascular resistance. These findings highlight distinct hemodynamic patterns in primary aldosteronism compared to essential hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Endocrinology
Background:
- Primary aldosteronism is a significant cause of secondary hypertension.
- Understanding its impact on circadian hemodynamics is crucial for risk stratification and management.
- Hypertension management often involves assessing 24-hour blood pressure patterns.
Purpose of the Study:
- To compare detailed circadian hemodynamic profiles in patients with primary aldosteronism versus essential hypertension.
- To identify specific hemodynamic markers associated with primary aldosteronism.
Main Methods:
- A comparative study involving 60 patients with primary aldosteronism and 120 with essential hypertension.
- Utilized an oscillometric device (Mobil-O-Graph) for 24-hour ambulatory monitoring of brachial and central blood pressure (BP), pulse wave velocity (PWV), augmentation index (AIx@75), cardiac index, and total vascular resistance (TVR).
Main Results:
- Patients with primary aldosteronism exhibited higher 24-hour brachial and central systolic blood pressure (SBP) compared to essential hypertension.
- A smaller difference between 24-hour brachial and central SBP (reduced pressure amplification) was observed in primary aldosteronism.
- Circadian variations in cardiac index and total vascular resistance were blunted in primary aldosteronism, with higher daytime TVR.
Conclusions:
- Circadian hemodynamics in primary aldosteronism are characterized by elevated central SBP, diminished pressure amplification, and disrupted diurnal BP and vascular resistance patterns.
- Primary aldosteronism is an independent predictor of abnormal 24-hour central SBP and pressure amplification.
Objective:
The present study aimed to compare circadian hemodynamic characteristics in hypertensive patients with and without primary aldosteronism.
Methods:
Circadian hemodynamics, including 24-h brachial and central blood pressure (BP), SBP variability indices, central pulse wave velocity (PWV), augmentation index (AIx@75), cardiac index, and total vascular resistance (TVR), were evaluated using an oscillometric device, Mobil-O-Graph, in 60 patients with primary aldosteronism (63.4±13.3 years, 47% women) and 120 age-matched and sex-matched patients with essential hypertension.
Results:
Office SBP, PWV, AIx@75, and BP variability indices were similar between groups; however, 24-h brachial (124 ± 14 vs 130 ± 11 mmHg) as well as central (112 ± 12 vs 120 ± 10 mmHg) SBP was higher (both P < 0.01), and the difference between 24-h brachial and central SBP (11 ± 5 vs 9 ± 3 mmHg, P < 0.05), an index of pressure amplification, was smaller in primary aldosteronism than in essential hypertension. In both groups, cardiac index decreased from daytime to night-time (both P < 0.01), but this decrease was smaller in primary aldosteronism (P < 0.05). During daytime, TVR in primary aldosteronism was higher than that in essential hypertension (P < 0.05), and the significant increase of TVR from daytime to night-time was lost in primary aldosteronism. In a multivariate stepwise regression model, primary aldosteronism emerged as an independent predictor of 24-h central SBP as well as the difference between 24-h brachial and central SBP.
Conclusion:
Our results demonstrated that circadian hemodynamics in primary aldosteronism patients are characterized by increased central SBP, smaller disparity between brachial and central SBP, and disturbed circadian hemodynamic variation.
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