CIRCADIAN BLOOD-PRESSURE VARIATION IN HYPERTENSIVE PATIENTS WITH PRIMARY HYPERALDOSTERONISM

A less-than-normal decline in nocturnal blood pressure (BP) has been a ssociated with excessive hypertensive complications. This is concernin g because secondary hypertension is often associated with this so-call ed nondipper BP profile. A nondipping pattern is more frequently found in the presence of pheochromocytoma, Cushing's syndrome, and sleep ap nea syndrome, but the prevalence is unclear in patients with primary h yperaldosteronism. We therefore studied ambulatory BP profiles in 16 h ypertensive patients with primary hyperaldosteronism and an equal numb er of essential hypertensive subjects. The awake-sleep BP difference o f the hyperaldosteronism patients was similar to that of essential hyp ertensives (15/14+/-3/2 versus 14/9+/-3/2 mm Hg, P=NS). The prevalence of dippers and nondippers (according to two distinct criteria) in the two groups was similar. Repeat ambulatory BP monitoring in 12 subject s with primary hyperaldosteronism after specific intervention (3 after surgical removal of an adrenal adenoma and 9 after commencement and t itration of spironolactone therapy) showed highly significant: reducti ons in office BP (22/10+/-6/4 mm Hg, P<.05) and awake and sleep BP. Ho wever, the extent of nocturnal BP decline was unchanged between the tw o studies (17/16+/-3/3 versus 16/12+/-2/2 mm Hg, P=NS). There was no c ell-elation between the awake-sleep difference and serum or urinary al dosterone levels or the aldosterone-to-renin ratio. In this study, we did not detect any differences in the awake-sleep differences between a group of hypertensives with primary hyperaldosteronism and a control group of essential hypertensives.