Aldosterone excess and resistance to 24-h blood pressure control.
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.
Pimenta
Eduardo
E
Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA. eduardo.pimenta@ccc.uab.edu
Gaddam
Krishna K
KK
Pratt-Ubunama
Monique N
MN
Nishizaka
Mari K
MK
Cofield
Stacey S
SS
Oparil
Suzanne
S
Calhoun
David A
DA
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
D000959:Antihypertensive Agents; D000450:Aldosterone; D012083:Renin