Sammendrag
Hypertension
with focus on refractory hypertension and primary hyperaldosteronism. 24 hour profile of ambulatory blood pressure measurements in a group of refractory hypertensive patients.
Background: Arterial hypertension is a common risk factor causing much morbidity and mortality. An uncommon but significant cause of hypertension is primary hyperaldosteronism. Reduced nocturnal fall in blood pressure (non-dipping) has been associated with increased cardiovascular morbidity. The objectives of this paper was 1: to give an introduction to hypertension with special focus on primary hyperaldosteronism and 2: to characterize the 24 hour blood pressure profile of a group of refractory hypertensive patients with focus on nocturnal dip. Methods: Patients with refractory hypertension underwent ambulatory blood pressure monitoring and were followed up as outpatients. Results: We had valid data from 63 patients of whom most had low plasma levels of renin. Patients were grouped according to their nocturnal fall in systolic blood pressure into dippers (>10% fall), non-dippers (<10% fall) and inverted dippers. The size of the systolic dip was strongly correlated to the size of the diastolic dip. There were significant differences between the groups for the following parameters: nocturnal systolic blood pressure, diurnal and nocturnal diastolic blood pressure and nocturnal middle arterial pressure. Discussion: Totally 42 (67%) of the patients had a nocturnal dip of less than 10%, which is a high percentage compared to studies of essential hypertensive patients. This finding might indicate that treatment resistance could be a contributing factor in reducing nocturnal dipping. Reduced dipping status has been associated with increased cardiovascular morbidity, but whether medical reversion of the dipping pattern reduces the cardiovascular risk is a question to be answered in future studies.