Effect of the operative treatment on the blood pressure (BP) variability in patients with primary aldosteronism (PA) remains to be elucidated. We studied the determinants of the morning minus evening systolic BP difference (ME difference) in self-measured BP in PA patients.Design and Method:
29 patients (male/female, 13/16, age 56.4 ± 12.12) were diagnosed with PA and underwent subtype differentiation according to the findings of adrenal venous sampling (AVS). The all patients with APA (alsosterone producing adenoma) were underwent adrenalectomy. We analyzed BP before and after the operative treatment of 30 days using self-measured BP monitoring in the morning and evening.Results:
The all patients took the ≥3 antihypertensive agents (3.59 ± 0.27), mainly MR antagonist (spironolactone or eplerenone) until operative treatment after AVS. The morning BP average was 124.11 ± 12.0 mmHg before operative treatment of 30 days. After the treatment, the plasma aldosterone concentrations (PAC:ng/ml) significantly decreased (38.0 ± 3.65 to 10.5 ± 5.0), and the number of antihypertensive agents were reduced (1.21+-0.187). 8/29 patients had not took antihypertensive agents after the treatment. The morning BP average was 125.17 ± 12.5 mmHg after operative treatment of 30 days, and was not significantly unchanged. However, the operative treatment significantly decreased the ME difference (ME average: before 11.35 ± 0.38 to after 9.64 ± 0.34 mmHg).Conclusions:
Morning blood pressure (BP) surge in ambulatory BP monitoring was a risk factor for stroke in previous studies. In the PA (APA) patients, the operative treatment more strongly reduced ME difference and depressed BP variability compared to pharmacotherapy, so that may be more useful to prevent cerebrovascular disease (CVD).