Comparison of ambulatory blood pressure between patients with primary aldosteronism and other forms of hypertension

Abstract

Objective Primary aldosteronism (PA) is a potentially curable cause of hypertension associated with worse cardiovascular prognosis than blood pressure‐matched essential hypertension (EH). Effective targeted treatment for PA is available with the greatest benefit seen if treatment is started early, prior to the development of end‐organ damage. However, PA is currently substantially under‐diagnosed. The standard screening test for PA, the aldosterone‐to‐renin ratio (ARR), is performed infrequently in both primary and tertiary care. In contrast, ambulatory blood pressure monitoring (ABPM) is frequently utilized in the assessment of hypertension. The aim of this study was to compare ABPM parameters in hypertensive patients with and without PA, in order to identify features of ABPM associated with PA that can prompt screening. Study design Patients with PA (n = 55) were identified from a tertiary clinic specializing in the management of endocrine causes of hypertension whilst the controls (n = 389) were consecutive patients with hypertension but without a known diagnosis of PA who were referred for ABPM. Results In this study, PA patients were younger and had higher 24‐h, day, and night‐time blood pressure compared with controls despite similar number of antihypertensive medications. However, there was no significant difference in nocturnal dipping or day‐night blood pressure variability between the two groups. Conclusions An elevated ambulatory blood pressure in patients on multiple antihypertensives could suggest underlying PA but in the absence of other distinguishing features, ABPM could not reliably differentiate PA from other forms of hypertension. Routine biochemical screening for PA remained the most reliable way of detecting this treatable secondary cause of hypertension.

Adrenal BORDeAux reGistry: Bordeaux single-center study of hypertensive patients with primary hyperaldosteronism

“…Precise hemodynamic status and blood pressure pheno-type determination at baseline does not allow us to distinguish primary aldosteronism subtypes from our current data. These results are in coherence with previous smaller studies, which do not find any significant difference between BP phenotype and primary aldosteronism subtypes even with essential hypertension [27][28][29].…”

Relation between blood pressure time in range and composite cardiovascular disease in patients with primary aldosteronism: a retrospective study

“…Recently, a relatively large sample study also demonstrated that nocturnal BP decline was lower in PA than in EH, whereas only patients with idiopathic hyperaldosteronism (IHA) had higher nighttime BP than those with EH [23]. However, previous studies have not analyzed BP load variation in patients with PA. Only a few studies have reported that patients with PA have a higher overall BP and BP load than patients with EH, despite no difference in dipping status [24]. Our data are the rst to suggest that the new indicator of nighttime SBP TIR is closely related to composite CVD events in patients with PA, whereas clinic BP, 24-hour SBP or DBP, daytime SBP or DBP, nighttime SBP or DBP, BP decline, daytime SBP or DBP TIR, and nighttime DBP TIR are not signi cantly related to those in patients with PA. Additionally, there were no signi cant differences in aldosteronism between patients with PA with and without composite CVD events.…”

“…Libianto et al reported that patients with PA had higher overall BP and BP load than patients with essential hypertension, despite no differences in nocturnal dipping or BP variability during 24-hour monitoring [9]. Furthermore, information on the relationship between the different ABPM hypertension phenotypes and cardiovascular complications in patients with PA is limited.…”

Primary aldosteronism

“…Further confounding diagnosis, primary aldosteronism can present like essential hypertension14: blood pressure can be anywhere from pre-hypertension (120-130/80-89 mm Hg) to resistant hypertension (resistant to three conventional antihypertensive drugs) 15. Hypokalaemia, once thought to be an essential feature of primary aldosteronism, is now found to be present in only a minority of patients (box 1).…”