Circadian Blood Pressure Variation in Hypertensive Patients With Primary Hyperaldosteronism

Abstract

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 awakeϪsleep BP difference of the hyperaldosteronism patients was similar to that of essential hypertensives (15/14Ϯ3/2 versus 14/9Ϯ3/2 mm Hg, PϭNS). 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 (22/10Ϯ6/4 mm Hg, PϽ.05) and awake and sleep BP. However, the extent of nocturnal BP decline was unchanged between the two studies (17/16Ϯ3/3 versus 16/12Ϯ2/2 mm Hg, PϭNS). There was no correlation between the awakeϪsleep difference and serum or urinary aldosterone levels or the aldosterone-to-renin ratio. In this study, we did not detect any differences in the awakeϪsleep differences between a group of hypertensives with primary hyperaldosteronism and a control group of essential hypertensives. (Hypertension. 1998;31:843-847.)Key Words: blood pressure, ambulatory Ⅲ hyperaldosteronism Ⅲ blood pressure variability Ⅲ hypertension, secondary T he circadian BP profile is likely a result of the complex interaction of neurological and hormonal circadian changes and the superimposed effects of physical and mental activity and posture.1,2 As part of this variation, there is a long-standing observation that BP decreases in the majority of normotensive and hypertensive subjects during sleep.3 Therefore, a terminology has come into practice for subjects with normal sleep BP decline who are labeled dippers and those with a less-thanexpected decline are called nondippers. These categories are not clearly defined, and the extent of BP reduction during sleep is affected by several factors such as age, sleep quality, and underlying comorbidity.3-5 For example, autonomic failure, Shy-Drager syndromes, 7 catecholamine excess states, 8 chronic renal failure, 9 Cushing's syndrome, 10 and diabetes mellitus 11 are all associated with an attenuation of the nocturnal BP decline. However, there are conflicting reports 8,12-17 on whether patients with primary hyperaldosteronism have a normal circadian BP profile.The issue of whether the BP profile is altered in subjects with primary hyperaldosteronism is a relevant one because the nondipper profile is associated with excess hypertensive complications. 18 -22 We theref...

Ambulatory Blood Pressure Monitoring in Secondary Arterial Hypertension Due to Adrenal Diseases

“…Our data regarding the lack of reduction of the nighttime BP in adrenal hypertension are similar to results reported in the literature in several pathophysiologic conditions, eg, autonomic failure, 30 severe renal failure, 31 PHEO, 5,6,32 hyperthyroidism, 32,33 hyperparathyroidism, 12,34 diabetes mellitus, 35 and Cushing's syndrome 6,7,9,32 . In particular, the nocturnal BP decrease was absent in a majority of patients with adrenal hypertension; these data are in accordance, in part, with results of other studies 5,6,9,32 .…”

“…Currently, the diagnosis of adrenal disorders is based on using a combination of precise analytic methods for the measurement of abnormal secretions of adrenal hormones and sophisticated radiologic techniques for the localization and characterization of specific adrenal lesions 2 . In recent years, several groups have described a disturbed circadian rhythm in blood pressure (BP) in some forms of endocrine hypertension by using indirect ambulatory measurements of BP 3–12 …”

Abolished nocturnal blood pressure fall in a boy with glucocorticoid-remediable aldosteronism

“…We could not find any relationship between BP levels and biochemical features of GRA. This finding is in agreement with the recent studies 14,15 showing no correlation between BP levels and biochemical values in patients with primary hyperaldosteronism caused by adenoma, bilateral hyperplasia or idiopathic hyperaldosteronism. Up to now, there are no similar data in patients with GRA.…”

Diurnal blood pressure variationin pheochromocytoma, primary aldosteronism and Cushing's syndrome

“…[1][2][3][4][5][6] However, these observations are of limited value because either a small number of studied subjects have been used in previous reports (especially in the case of pheochromocytoma) or controversial results have been published regarding the circadian BP pattern in primary aldosteronism and also in pheochromocytoma. 1,2,[7][8][9][10][11][12][13][14] Until now, no study has been focused on differences in diurnal BP variations between the steroid-and catecholamine-induced hypertension.…”