Hypertensjon med fokus på refraktær hypertensjon og primær hyperaldosteronisme. Beskrivelse av døgnprofil ved ambulatoriske blodtrykksmålinger hos en gruppe refraktært hypertensive pasienter

Abstract

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.