From the Section of Hypertension and Vascular Diseases, University of
Connecticut School of Medicine (Farmington).
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 awake-sleep BP difference of the
hyperaldosteronism patients was similar to that of essential
hypertensives (15/14±3/2 versus 14/9±3/2 mm Hg,
P=NS). 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 (22/10±6/4 mm Hg, P<.05) and awake and sleep
BP. However, the extent of nocturnal BP decline was unchanged between
the two studies (17/16±3/3 versus 16/12±2/2 mm Hg,
P=NS). There was no correlation between the awake-sleep
difference and serum or urinary aldosterone levels or the
aldosterone-to-renin ratio. In this study, we did not
detect any differences in the awake-sleep differences between a group
of hypertensives with primary hyperaldosteronism and a control group of
essential hypertensives.
© 1998 American Heart Association, Inc.
Scientific Contributions
Circadian Blood Pressure Variation in Hypertensive Patients With Primary Hyperaldosteronism
Key Words: blood pressure, ambulatory • hyperaldosteronism • blood pressure variability • hypertension, secondary