Higher ambulatory blood pressure and less white-coat effect in subjects with hyperaldosteronism and resistant hypertension

Pimenta, Eduardo, Pratt-Ubunama, Monique N., Gaddam, Krishna K., Nishizaka, Mari K. and Calhoun, David A. (2006). Higher ambulatory blood pressure and less white-coat effect in subjects with hyperaldosteronism and resistant hypertension. In: Hypertension. Abstracts from the 60th Annual Fall Conference and Scientific Sessions of Council for High Blood Pressure Research. 60th Annual Fall Conference and Scientific Sessions of Council for High Blood Pressure Research, San Antonio, TX, USA, (e41-e41). 4-7 October 2006.

Author Pimenta, Eduardo
Pratt-Ubunama, Monique N.
Gaddam, Krishna K.
Nishizaka, Mari K.
Calhoun, David A.
Title of paper Higher ambulatory blood pressure and less white-coat effect in subjects with hyperaldosteronism and resistant hypertension
Conference name 60th Annual Fall Conference and Scientific Sessions of Council for High Blood Pressure Research
Conference location San Antonio, TX, USA
Conference dates 4-7 October 2006
Proceedings title Hypertension. Abstracts from the 60th Annual Fall Conference and Scientific Sessions of Council for High Blood Pressure Research   Check publisher's open access policy
Place of Publication Baltimore, MD
Publisher Lippincott Williams & Wilkins for the American Heart Association
Publication Year 2006
ISSN 0194-911X
Volume 48
Issue 4
Start page e41
End page e41
Total pages 1
Language eng
Formatted Abstract/Summary
Background:
Ambulatory blood pressure (BP) better predicts cardiovascular outcomes than office BP. The effects of hyperaldosteronism on ambulatory BP levels and circadian BP variation are not well established.

Objective:
The purpose of this study was to compare the 24-hr ambulatory blood pressure monitoring (ABPM) profile and the degree of white-coat effect (WCE - daytime ambulatory BP at least 10 mmHg office BP) in resistant hypertensive subjects with or without hyperaldosteronism.

Methods:
One hundred thirty-eight subjects with resistant hypertension were prospectively evaluated with an early-morning plasma aldosterone and plasma renin activity (PRA), 24-hour urinary aldosterone and sodium, and 24-hr ABPM. Daytime, nighttime and 24-hr blood pressure as well as nocturnal BP decline and the morning BP surge were determined. Hyperaldosteronism (H-Aldo) was defined as suppressed PRA (1.0 ng/mL/hr) and elevated 24-hr urinary aldosterone excretion (12 g/24h) in sodium replete subjects (200 mEq/24-hr).

Results:
Overall, the mean office BP was 160.325.9/ 89.816.3 mmHg on an average of 4 medications. There was no difference in mean office BP values between the 45 subjects with H-Aldo and the 93 subjects with normal aldosterone levels (N-Aldo). However, systolic daytime (149.215.2 vs 138.617.4mmHg, p0.0007), diastolic daytime (89.48.8 vs 80.513.7mmHg, p0.0001), systolic nighttime (143.116.4 vs 130.917.8mmHg, p0.0002), diastolic nighttime (82.810.1 vs 73.514.2mmHg, p0.0001), 24-hr systolic (146.814.6 vs 135.717.0mmHg, p0,0003) and 24-hr diastolic (86.618.8 vs 77.913.8mmHg, p0.0002) BP were all higher in H-Aldo than N-Aldo subjects. A WCE was present in 46% of the H-Aldo subjects but only 13% of N-Aldo. Nocturnal dipping was not different in the 2 aldosterone groups. The systolic morning surge was 17.411.3 mm Hg in the H-Aldo subjects and 19.213.7 mm Hg in the N-Aldo subjects (pNS).

Conclusions:
In spite of similar office BP, daytime and night ambulatory BP levels are higher and there is less WCE in resistant hypertensive subjects with high aldosterone levels. These results suggest that high aldosterone levels impart increased cardiovascular risk not reflected by office blood pressure measurements.
Subjects 1103 Clinical Sciences
1102 Cardiovascular Medicine and Haematology
Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status Unknown

 
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Created: Thu, 04 Mar 2010, 14:11:01 EST by Laura McTaggart on behalf of Faculty Of Health Sciences