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Circadian blood pressure variation in hypertensive patients with primary hyperaldosteronism
1Section of Hypertension and Vascular Diseases, University of Connecticut School of Medicine, Farmington 06030-3940, USA.
Insights
The study found that patients with primary hyperaldosteronism do not show a different nocturnal blood pressure (BP) dipping pattern compared to essential hypertension patients. Treatments for primary hyperaldosteronism improved BP but did not alter the BP dipping pattern.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- A reduced nocturnal decline in blood pressure (BP), known as the nondipper profile, is linked to increased hypertensive complications and secondary hypertension.
- Nondipping patterns are common in conditions like pheochromocytoma, Cushing's syndrome, and sleep apnea, but their prevalence in primary hyperaldosteronism is not well-established.
Purpose of the Study:
- To investigate the prevalence of the nondipper BP profile in patients with primary hyperaldosteronism.
- To compare ambulatory BP profiles, specifically the awake-sleep BP difference, between patients with primary hyperaldosteronism and essential hypertension.
- To assess the impact of interventions on BP and the nocturnal dipping pattern in primary hyperaldosteronism.
Main Methods:
- Ambulatory BP monitoring was conducted on 16 hypertensive patients with primary hyperaldosteronism and 16 age- and sex-matched essential hypertensive subjects.
- BP profiles were re-evaluated in 12 primary hyperaldosteronism patients after treatment (adrenal adenoma removal or spironolactone therapy).
- The awake-sleep BP difference and the prevalence of dippers and nondippers were analyzed using two distinct criteria.
Main Results:
- The awake-sleep BP difference in primary hyperaldosteronism patients was comparable to that of essential hypertensive subjects.
- The prevalence of dippers and nondippers was similar between the two groups.
- Interventions significantly reduced office and ambulatory BP but did not alter the extent of nocturnal BP decline.
Conclusions:
- Patients with primary hyperaldosteronism do not exhibit a distinct nocturnal blood pressure dipping pattern compared to essential hypertensives.
- Effective treatments for primary hyperaldosteronism lower overall BP but do not change the established nocturnal BP dipping characteristics.
Abstract:
A less-than-normal decline in nocturnal blood pressure (BP) has been associated with excessive hypertensive complications. This is concerning because secondary hypertension is often associated with this so-called nondipper BP profile. A nondipping pattern is more frequently found in the presence of pheochromocytoma, Cushing's syndrome, and sleep apnea syndrome, but the prevalence is unclear in patients with primary hyperaldosteronism. We therefore studied ambulatory BP profiles in 16 hypertensive patients with primary hyperaldosteronism and an equal number of essential hypertensive subjects. The awake-sleep BP difference of the hyperaldosteronism patients was similar to that of essential hypertensives (15/14 +/- 3/2 versus 14/9 +/- 3/2 mm Hg, P=NS). The prevalence of dippers and nondippers (according to two distinct criteria) in the two groups was similar. Repeat ambulatory BP monitoring in 12 subjects with primary hyperaldosteronism after specific intervention (3 after surgical removal of an adrenal adenoma and 9 after commencement and titration of spironolactone therapy) showed highly significant reductions in office BP (22/10 +/- 6/4 mm Hg, P<.05) and awake and sleep BP. However, the extent of nocturnal BP decline was unchanged between the two studies (17/16 +/- 3/3 versus 16/12 +/- 2/2 mm Hg, P=NS). There was no correlation between the awake-sleep difference and serum or urinary aldosterone levels or the aldosterone-to-renin ratio. In this study, we did not detect any differences in the awake-sleep differences between a group of hypertensives with primary hyperaldosteronism and a control group of essential hypertensives.