Article Text

PDF
176 ALDOSTERONE EXCESS IS ASSOCIATED WITH TRUE TREATMENT RESISTANCE AS INDICATED BY SUSTAINED AMBULATORY BLOOD PRESSURE LEVELS AND LESS WHITE-COAT EFFECT.
  1. E. Pimenta1,
  2. M. N. Pratt-Ubunama1,
  3. K. K. Gaddam1,
  4. M. K Nishizaka1,
  5. S. Oparil1,
  6. D. A. Calhoun1
  1. 1Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL.

Abstract

Purpose Ambulatory blood pressure (BP) better predicts cardiovascular outcomes than office BP. The purpose of this study was to compare the 24-hour ambulatory blood pressure monitoring (ABPM) profile and the degree of white-coat effect (WCE) in resistant hypertensive subjects with or without hyperaldosteronism.

Methods Two hundred fifty-two subjects with resistant hypertension were prospectively evaluated with an early-morning plasma aldosterone and plasma renin activity (PRA), 24-hour urinary aldosterone and sodium, and 24-hour ABPM. Daytime, nighttime, and 24-hour blood pressure as well as nocturnal BP decline were determined. Hyperaldosteronism (H-Aldo) was defined as suppressed PRA (< 1.0 ng/mL/h) and elevated 24-hour urinary aldosterone excretion (> 12 μg/24 h).

Results Overall, the mean office BP was 160.0 ± 25.2/89.4 ± 15.3 mm Hg on an average of 4.2 medications. There was no difference in mean office BP values between the 59 subjects with H-Aldo and the 193 subjects with normal aldosterone levels (N-Aldo). However, daytime systolic (150.6 ± 14.6 vs 140.7 ± 18.0 mm Hg, p = .0002), daytime diastolic (88.8 ± 8.7 vs 82.4 ± 13.7 mm Hg, p = .0009), nighttime systolic (147.0 ± 17.2 vs 133.9 ± 18.6 mm Hg, p < .0001), nighttime diastolic (83.6 ± 8.7 vs 75.5 ± 13.9 mm Hg, p < .0001), 24-hour systolic (149.1 ± 15.2 vs 138.2 ±17.6 mm Hg, p < .0001), and 24-hour diastolic (86.7 ± 8.9 vs 79.8 ± 13.3 mm Hg, p = .0002) BP were all higher in H-Aldo than N-Aldo subjects. A WCE was present in 36.8% of the N-Aldo subjects but only 6.8% of H-Aldo. Systolic and diastolic nocturnal decline tended to be lower in patients with H-Aldo compared with N-Aldo.

Conclusions In spite of similar office BP, daytime, nighttime, and 24-hour ABPM levels were higher and there was less WCE in resistant hypertensive subjects with H-Aldo. These results suggest that high aldosterone levels impart increased cardiovascular risk not reflected by office BP measurements.

Statistics from Altmetric.com

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.