Hyperaldosteronism in resistant hypertensive patients was associated with significantly higher 24-hour ambulatory blood pressure levels despite similar mean office blood pressures (160.0/89.4 mmHg).
Observational (n=251)
Does hyperaldosteronism increase 24-h ambulatory blood pressure levels in patients with resistant hypertension?
In patients with resistant hypertension, hyperaldosteronism is associated with higher 24-hour ambulatory blood pressure despite similar office blood pressure, suggesting higher cardiovascular risk.
BACKGROUND: Aldosterone excess has been reported to be a common cause of resistant hypertension. To what degree this represents true treatment resistance is unknown. OBJECTIVE: The present study aimed to compare the 24-h ambulatory blood pressure monitoring (ABPM) levels in resistant hypertensive patients with or without hyperaldosteronism. METHODS: Two hundred and fifty-one patients with resistant hypertension were prospectively evaluated with an early-morning plasma renin activity (PRA), 24-h urinary aldosterone and sodium, and 24-h ABPM. Daytime, night-time, and 24-h blood pressure (BP) and nocturnal BP decline were determined. Hyperaldosteronism (H-Aldo) was defined as suppressed PRA (/= 12 mug/24-h or >/= 33.2 nmol/day) during ingestion of the patient's routine diet. RESULTS: In all patients, the mean office BP was 160.0 +/- 25.2/89.4 +/- 15.3 mmHg on an average of 4.2 medications. There was no difference in mean office BP between H-Aldo and normal aldosterone status (N-Aldo) patients. Daytime, night-time, and 24-h systolic and diastolic BP were significantly higher in H-Aldo compared to N-Aldo males. Daytime, night-time, and 24-h systolic BP were significantly higher in H-Aldo compared to N-Aldo females. Multivariate analysis indicated a significant interaction between age and aldosterone status such that the effects of aldosterone on ambulatory BP levels were more pronounced with increasing age. CONCLUSIONS: In spite of similar office BP, ABPM levels were higher in resistant hypertensive patients with H-Aldo. These results suggest that high aldosterone levels impart increased cardiovascular risk not reflected by office BP measurements.
Pimenta et al. (Mon,) conducted a observational in Resistant hypertension (n=251). Hyperaldosteronism vs. Normal aldosterone status was evaluated on 24-h ambulatory blood pressure monitoring (ABPM) levels. Hyperaldosteronism in resistant hypertensive patients was associated with significantly higher 24-hour ambulatory blood pressure levels despite similar mean office blood pressures (160.0/89.4 mmHg).