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High plasma aldosterone concentration is associated with worse 24-h ambulatory blood pressure profile in patients with primary aldosteronism

Hypertension Research volume 46, pages 1995–2004 (2023)Cite this article

Abstract

Patients with primary aldosteronism (PA) have a higher risk of cardiovascular disease (CVD) than essential hypertension due to underlying hyperaldosteronism. However, the association between high plasma aldosterone concentrations (PACs) and diurnal blood pressure (BP) variation has not been fully elucidated. Because abnormal ambulatory blood pressure monitoring (ABPM) profiles are associated with increased CVD risk, we investigated the association between PACs and the ABPM profile in 36 patients with PA diagnosed by confirmatory tests who underwent adrenal venous sampling (AVS). The clinical parameters were measured during hospitalization for AVS. The dietary salt intake of hospitalized patients was controlled at 6 g/day. During AVS, blood samples were collected from the inferior vena cava before and 1 h after adrenocorticotropic hormone (ACTH) stimulation to measure the PACs. The post-stimulation PAC had a significant negative correlation with nocturnal BP dipping rates (R = −0.387, p = 0.020), whereas pre-stimulation PAC did not (R = −0.217, p = 0.204). The nocturnal BP dipping rates were significantly lower in the high PAC group (PAC higher than the median) than low PAC group (PAC lower than the median) (p = 0.009). Multiple regression analysis revealed that high PAC was an independent factor contributing to low nocturnal BP dipping rates (β = −0.316, p = 0.038). In conclusion, in patients with PA, hyperaldosteronism is associated with nocturnal hypertension, which is an important risk factor for CVD. Additionally, ACTH stimulation may improve the sensitivity of PACs as a clinical indicator of nocturnal hypertension.

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All relevant data are included within the paper. The datasets are available from the corresponding authors upon reasonable request.

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Acknowledgements

We thank Textcheck for editing and reviewing the English in this manuscript.

Funding

This work was supported by grants from the Yokohama Foundation for Advancement of Medical Science; Uehara Memorial Foundation; Japan Society for the Promotion of Science; Japan Kidney Association-Nippon Boehringer Ingelheim Joint Research Program; Japanese Association of Dialysis Physicians; Salt Science Research Foundation; Strategic Research Project of Yokohama City University; Japan Agency for Medical Research and Development (AMED); Translational Research Program; Strategic Promotion for Practical Application of Innovative Medical Technology (TR-SPRINT) from AMED; Moriya Scholarship Foundation; Bayer Scholarship for Cardiovascular Research; and Mochida Memorial Foundation for Medical and Pharmaceutical Research.

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  1. These authors contributed equally: Ryutaro Morita, Kengo Azushima.

Authors and Affiliations

  1. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Ryutaro Morita, Kengo Azushima, Sumire Sunohara, Tatsuya Haze, Ryu Kobayashi, Sho Kinguchi, Tomohiko Kanaoka, Kazuo Kobayashi, Yoshiyuki Toya, Hiromichi Wakui & Kouichi Tamura

  2. Department of Nephrology and Hypertension, Yokohama Minami Kyousai Hospital, Yokohama, Japan

    Sumire Sunohara

  3. YCU Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan

    Tatsuya Haze

  4. Committee of Hypertension and Kidney Disease, Kanagawa Physicians Association, Yokohama, Japan

    Kazuo Kobayashi

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Contributions

KA designed and conducted the research. KA, RM, TH, KK, HW, and KT wrote the manuscript. KA, RM, SS, RK, SK, TK, YT, and HW performed the research. KA, RM, SS, and TH analyzed the data. KT supervised the research. All authors approved the final manuscript.

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Correspondence to Kengo Azushima or Hiromichi Wakui.

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Morita, R., Azushima, K., Sunohara, S. et al. High plasma aldosterone concentration is associated with worse 24-h ambulatory blood pressure profile in patients with primary aldosteronism. Hypertens Res 46, 1995–2004 (2023). https://doi.org/10.1038/s41440-023-01325-8

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