title: Negative association between plasma aldosterone concentration/plasma renin activity and morning blood pressure surge in never-treated hypertensive patients.
abstract: Morning blood pressure (BP) surge (MS) has been known to be a predictor of cardiovascular events. Currently, few studies have evaluated the underlying mechanism underlying MS, which may include neurohormonal factors and the renin-angiotensin-aldosterone system (RAAS). This study aimed to examine plasma aldosterone concentration (PAC) and plasma renin activity (PRA) and BP parameters with or without MS in never-treated subjects with essential hypertension. This cross-sectional study included a total of 261 patients (mean age: 48.8 years; 60.5% male) with never-treated essential hypertension who were registered in a working group at The Catholic University of Korea. The patients were divided into the MS group, which was defined as having the highest quartile of morning BP increase from sleep (>31 mmHg; n = 66) and the non-MS group (≤31 mmHg; n = 195). We collected 24-h ambulatory BP, pulse wave velocity, ankle brachial index, PAC and PRA from all patients. The measured PAC and PRA were lower in the MS group than in the non-MS group (PAC: 9.0 ± 5.4 ng/dl versus 12.2 ± 8.7 ng/dl, p < 0.001; PRA: 1.7 ± 1.3 ng/ml/h versus 2.6 ± 3.6 ng/ml/h, p = 0.002). The MS group had greater variations in daytime, nighttime and 24-h systolic blood pressure (SBPs) than the non-MS group (24-h SBP: 15.6 ± 4.4 mm Hg for the non-MS group and 18.9 ± 4.9 mmHg for the MS group; p < 0.001 for each). It is generally accepted that the sympathetic nervous system plays a major role in the regulation of BP variability. Therefore, further studies on sympathetic nervous system activation in hypertensives with extreme MS are needed. MS in enrolled patients who were at relatively low risk in this study may be less affected by the RAAS.
authors.affiliation: Department of Cardiology, Daejeon St. Mary's Hospital , Daejeon , Korea .
authors.forename: Jung Sun
authors.initials: JS
authors.lastname: Cho
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Ihm
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Jang
authors.forename: Woo-Baek
authors.initials: WB
authors.lastname: Chung
authors.forename: Yun-Seok
authors.initials: YS
authors.lastname: Choi
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Shin
authors.forename: Suk Min
authors.initials: SM
authors.lastname: Seo
authors.forename: Mahn-Won
authors.initials: MW
authors.lastname: Park
authors.forename: Gee Hee
authors.initials: GH
authors.lastname: Kim
authors.forename: Sung-ho
authors.initials: SH
authors.lastname: Her
authors.forename: Chan Joon
authors.initials: CJ
authors.lastname: Kim
authors.forename: Tae-Hoon
authors.initials: TH
authors.lastname: Kim
authors.forename: Min Kyu
authors.initials: MK
authors.lastname: Kang
authors.forename: Kiyuk
authors.initials: K
authors.lastname: Chang
authors.forename: Chan Seok
authors.initials: CS
authors.lastname: Park
mesh_terms: D000450:Aldosterone / Q000097:blood*; D055109:Ankle Brachial Index; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012083:Renin / Q000097:blood*; D012084:Renin-Angiotensin System / Q000502:physiology*; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D000450:Aldosterone; D012083:Renin
keywords: BP variability; morning BP surge; never-treated hypertension; plasma aldosterone concentration; plasma renin activity