title: Aldosterone excess and resistance to 24-h blood pressure control.
abstract: BACKGROUND
  Aldosterone excess has been reported to be a common cause of resistant hypertension. To what degree this represents true treatment resistance is unknown.
  
  
  OBJECTIVE
  The present study aimed to compare the 24-h ambulatory blood pressure monitoring (ABPM) levels in resistant hypertensive patients with or without hyperaldosteronism.
  
  
  METHODS
  Two hundred and fifty-one patients with resistant hypertension were prospectively evaluated with an early-morning plasma renin activity (PRA), 24-h urinary aldosterone and sodium, and 24-h ABPM. Daytime, night-time, and 24-h blood pressure (BP) and nocturnal BP decline were determined. Hyperaldosteronism (H-Aldo) was defined as suppressed PRA (<1.0 ng/ml per h or <1.0 mug/l per h) and elevated 24-h urinary aldosterone excretion (>/= 12 mug/24-h or >/= 33.2 nmol/day) during ingestion of the patient's routine diet.
  
  
  RESULTS
  In all patients, the mean office BP was 160.0 +/- 25.2/89.4 +/- 15.3 mmHg on an average of 4.2 medications. There was no difference in mean office BP between H-Aldo and normal aldosterone status (N-Aldo) patients. Daytime, night-time, and 24-h systolic and diastolic BP were significantly higher in H-Aldo compared to N-Aldo males. Daytime, night-time, and 24-h systolic BP were significantly higher in H-Aldo compared to N-Aldo females. Multivariate analysis indicated a significant interaction between age and aldosterone status such that the effects of aldosterone on ambulatory BP levels were more pronounced with increasing age.
  
  
  CONCLUSIONS
  In spite of similar office BP, ABPM levels were higher in resistant hypertensive patients with H-Aldo. These results suggest that high aldosterone levels impart increased cardiovascular risk not reflected by office BP measurements.
authors: Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA. eduardo.pimenta@ccc.uab.edu
authors: Eduardo
authors: E
authors: Pimenta
authors: Krishna K
authors: KK
authors: Gaddam
authors: Monique N
authors: MN
authors: Pratt-Ubunama
authors: Mari K
authors: MK
authors: Nishizaka
authors: Stacey S
authors: SS
authors: Cofield
authors: Suzanne
authors: S
authors: Oparil
authors: David A
authors: DA
authors: Calhoun
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000450:Aldosterone / Q000652:urine; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D016022:Case-Control Studies; D002940:Circadian Rhythm; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications* / Q000503:physiopathology*; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012083:Renin / Q000097:blood
chemical_list: D000959:Antihypertensive Agents; D000450:Aldosterone; D012083:Renin