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Diurnal blood pressure pattern and cardiac damage in hypertensive patients with primary aldosteronism

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Abstract

Purpose

The aim of our study was to evaluate the relationship between the 24-h blood pressure (BP) profile, plasma NT-proBNP levels and left ventricular hypertrophy (LVH) in subjects with primary aldosteronism (PA) compared to patients with essential hypertension (EH).

Methods

A total of 385 consecutive patients with PA [187 with aldosterone producing adenoma (APA) and 198 with idiopathic hyperaldosteronism (IHA)] and 385 patients with EH were matched based on age, sex, body mass index (BMI), BP values and duration of hypertension. Twenty-four-hour ambulatory BP monitoring (ABPM), plasma levels of NT-proBNP, left ventricular mass index (LVMI), and other clinical medical data were assessed in all patients.

Results

No differences in age, sex, BMI, clinical BP, 24-h mean BP, daytime BP, or duration of hypertension were found between groups. Nighttime systolic BP (130 ± 16 vs. 127 ± 17 mmHg, p < 0.05) and diastolic BP (82 ± 10 vs. 79 ± 11 mmHg, p < 0.01) were higher in PA patients than in EH patients. In addition, nocturnal BP decline was reduced, while median NT-proBNP (53.7 vs. 33.2 pg/ml, P < 0.001) and LVMI (113 ± 25 vs. 102 ± 26 g/m2, P < 0.001) were higher in PA patients than in EH patients. Moreover, the median NT-proBNP level was higher in APA patients than in IHA patients (68.0 vs. 42.4 pg/ml, P < 0.001). In stepwise multivariate regression analysis, LVMI was correlated with NT-proBNP, nighttime systolic BP and sex in PA patients.

Conclusions

Patients with PA show higher nighttime BP and NT-proBNP levels and lower nocturnal BP decline than those with EH. In addition, higher nocturnal systolic BP has been shown to be strongly associated with cardiac damage in PA patients.

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Acknowledgements

This study was supported by the National Natural Science Foundation of China [81800339, 81900440], Natural Science Foundation of Shanghai Science and Technology Committee [18ZR1431800], and Fund of Shanghai Municipal Commission of Health and Family Planning [201940413, 20194Y0171].

Funding

This study was supported by the National Natural Science Foundation of China [81800339, 81900440], Natural Science Foundation of Shanghai Science and Technology Committee [18ZR1431800], and Fund of Shanghai Municipal Commission of Health and Family Planning [201940413, 20194Y0171].

Author contributions

Substantially contributed to conception or design: Q.W. and M.H.; contributed to acquisition, analysis, or interpretation of data: Q.W. and M.H.; drafted the manuscript: J.X., X.T., and L.Z.; critically revised the manuscript for important intellectual content: P.G.; gave final approval: J.X. and J.W.

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Author notes

  1. These authors contributed equally: Qihong Wu, Mona Hong

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Qihong Wu, Mona Hong, Jianzhong Xu, Xiaofeng Tang, Limin Zhu, Pingjin Gao & Jiguang Wang

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  1. Qihong Wu
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Correspondence to Jianzhong Xu.

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Wu, Q., Hong, M., Xu, J. et al. Diurnal blood pressure pattern and cardiac damage in hypertensive patients with primary aldosteronism. Endocrine 72, 835–843 (2021). https://doi.org/10.1007/s12020-021-02606-3

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