Key result
Adrenalectomy, cobalamin, and CPAP improve BP and increase baroreflex sensitivity ~196% in a primary aldosteronism patient.
Why the study?
Primary aldosteronism is a frequent cause of secondary arterial hypertension, but whether it is associated with masked hypertension was unknown.
Does unilateral adrenalectomy, cobalamin supplementation, and CPAP improve blood pressure control and baroreflex sensitivity in a patient with masked hypertension and primary aldosteronism?
Case Report (n=1)
Does unilateral adrenalectomy, cobalamin supplementation, and CPAP improve blood pressure control and baroreflex sensitivity in a patient with masked hypertension and primary aldosteronism?
This case highlights that hypertension can be masked by coexisting baroreceptor dysfunction, which may be reversible following treatment of underlying causes like primary aldosteronism.
Hypothesis-generating for reversible baroreflex dysfunction in primary aldosteronism; leaves open multimodal therapy benefit in masked hypertension.
PURPOSE: Primary aldosteronism is one of the most frequent causes of secondary arterial hypertension, and whether primary aldosteronism is associated with masked hypertension is unknown. MATERIALS AND METHODS: We describe a 64-year-old man with a history of hypothyroidism, recurring hypokalaemia, and normal home and office blood pressure values. Ambulatory blood pressure monitoring revealed masked hypertension with strikingly high systolic blood pressure variability and typical hypertension-mediated organ damage. RESULTS: The patient required gradual escalation of antihypertensive medication to four drugs. During the diagnostic process we identified primary aldosteronism, cobalamin deficiency, severe obstructive sleep apnoea, and low baroreflex sensitivity (1.63 ms/mmHg). Following unilateral adrenalectomy, cobalamin supplementation and continuous positive airway pressure, we observed a spectacular improvement in the patient's blood pressure control, baroreflex sensitivity (4.82 ms/mmHg) and quality of life. CONCLUSIONS: We report an unusual case of both masked arterial hypertension and primary aldosteronism. Elevated blood pressure values were masked in home and office measurements by coexisting hypotension which resulted most probably from deteriorated baroreflex sensitivity. Baroreflex sensitivity increased following treatment, including unilateral adrenalectomy. Hypertension can be masked by coexisting baroreceptor dysfunction which may derive from structural but also functional reversible changes.
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Kanarek-Kucner et al. (2021) conducted a case report in Primary aldosteronism and masked arterial hypertension (n=1). Unilateral adrenalectomy, cobalamin supplementation, and continuous positive airway pressure was evaluated on Blood pressure control, baroreflex sensitivity, and quality of life. Unilateral adrenalectomy, cobalamin supplementation, and CPAP improved blood pressure control and increased baroreflex sensitivity from 1.63 to 4.82 ms/mmHg in a patient with primary aldosteronism.
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