The Association between a 24-Hour Blood Pressure Pattern and Circadian Change in Plasma Aldosterone Concentration for Patients with Aldosterone-Producing Adenoma.

Hai Li,Guohong Wei,Liehua Liu,Yanbing Li,Wanping Deng,Minmin Huang,Zhimin Huang,Juan Liu,Xiaopei Cao,Jianbin Liu,Haipeng Xiao

doi:10.1155/2019/4828402

Abstract

The absence of nocturnal blood pressure (BP) decline is associated with hypertensive complications. Data regarding circadian BP patterns in patients with aldosterone-producing adenoma (APA) are limited and equivocal. We evaluated the circadian BP profile in patients with APA and its relationship with the circadian aldosterone rhythm. BP in patients with APA and in those with essential hypertension (EH) were assessed through in-hospital 24-h ambulatory blood pressure monitoring. Over a 24-h in-hospital period, plasma aldosterone levels taken at midnight, 0400, 0800, 1200, 1600, and 2000 h were measured. To evaluate a correlation between BP and hormone rhythm, we included 27 patients with APA (APA group) and 27 patients with EH (EH group). Both groups had similar age, sex ratio, body mass index, duration of hypertension, family history of hypertension, and lipid profiles. The day-night BP differences in both patient groups were similar, whether expressed as absolute values or percentages. The proportions of patients with dipping BP profiles were also comparable (APA group, 5 of 27; EH group, 7 of 27; χ2 = 0.429; P = 0.513). At each time point, APA group plasma aldosterone concentrations (PACs) were higher than those of the EH group. A circadian change in relation to PAC was observed in both groups. A correlation between PAC and BP was statistically nonsignificant in most study patients in either group. Our data indicated that the circadian BP pattern was not associated with a change in PAC levels in patients with APA.

Highlights

Observational studies have shown a 10%–20% decline in blood pressure (BP) levels during sleep at night in most normotensive individuals and in patients with essential hypertension [1, 2]
A nondipping BP pattern is associated with hypertensive complications [3]
Previous studies have reported that a circadian BP decline was blunted in aldosterone-producing adenoma (APA) patients [4, 5], which might contribute to increased cardiovascular disease risk in this population

Summary

Introduction

Observational studies have shown a 10%–20% decline in blood pressure (BP) levels during sleep at night in most normotensive individuals and in patients with essential hypertension [1, 2]. The term “dipper” refers to individuals with normal nocturnal fall of blood pressure (BP) and “nondipper” refers to those whose BP does not fall nocturnally. Data regarding circadian BP patterns in patients with aldosterone-producing adenoma (APA) are limited and equivocal. Previous studies have reported that a circadian BP decline was blunted in APA patients [4, 5], which might contribute to increased cardiovascular disease risk in this population. It is generally known that, in aldosteronism, overproduction of aldosterone leads to increased sodium and water retention and subsequent hypertension via its genomic effect, which is a relatively long-term action. Recent studies [6] have revealed rapid effects of aldosterone on vascular tone; raising the possibility that aldosterone might play a role in short-term BP regulation

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