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Primary aldosteronism’s ’24-hour profile’ leads to increased blood pressure load
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NEW ORLEANS — Adults with primary aldosteronism may endure greater blood pressure burden, including substantial losses in nocturnal BP dipping, than those without the condition, according to findings presented at the Endocrine Society Annual Meeting.
“Primary aldosteronism is substantially underdiagnosed,” Jun Yang, MBBS, PhD, FRACP, a research fellow at Hudson Institute of Medical Research, postdoctoral research fellow at the School of Clinical Sciences of Monash University and a consultant endocrinologist at Monash Health in Australia, told Endocrine Today. “However, it is associated with higher cardiovascular risk than essential hypertension and is either curable or has targeted treatment. To facilitate the early detection of this disease, we need to identify disease-specific diagnostic parameters.”
Yang and colleagues retrospectively evaluated ambulatory BP monitoring data from 453 adults who received care at Monash Heart in Victoria, Australia. There were 39 patients with primary aldosteronism and 414 with BP-matched essential hypertension. CV events of each group were recorded, and medical records were used to confirm demographic information, aldosterone and renin concentrations, and medication history. BP load was also evaluated and defined as the percentage of daytime with a BP more than 135/85 mm Hg and the percentage of nighttime with a BP more than 120/70 mm Hg.
The researchers found that patients with primary aldosteronism were younger and had higher systolic and diastolic BP than those without. These patients also had a higher systolic BP load (83%; 95% CI, 61-92) compared with the group without the condition (48%; 95% CI, 23-75). The same was true of diastolic BP load, with patients with primary aldosteronism at 57% (95% CI, 35-76) and the rest of the cohort at 14% (95% CI, 5-35). The researchers further found a loss of nocturnal BP dipping in 77% of patients with primary aldosteronism compared with 44% of those without the condition. When pooled together, these findings pointed to a “distinctive 24-hour BP profile” for patients with primary aldosteronism, according to the abstract.
“Physicians who report 24-hour blood pressure parameters could highlight the loss of nocturnal dipping together with the high blood pressure load and recommend screening for a secondary cause of hypertension in the conclusion of their report,” Yang said. “This should increase the likelihood of a timely diagnosis of primary aldosteronism before nonspecific antihypertensive medications are started and before end-organ damage has occurred.” – by Phil Neuffer
Reference:
Yang J, et al. SAT-056. Primary aldosteronism has a distinctive twenty-four hour blood pressure profile. Presented at: The Endocrine Society Annual Meeting; March 23-26, 2019; New Orleans.
Disclosure: Yang reports no relevant financial disclosures.