Clinical Characteristics Of Nocturnal Blood Pressure And Left Ventricular Structure And Their Influencing Factors In Patients With Primary Aldosteronism

【Background】As is known,the typical clinical features of primary aldosteronism(primary aldosteronism,PA)includes hypertension,hypokalemia,high blood aldosterone and low renin activity,the patients often have a headache,soft leg fatigue,nocturia and other symptoms [1,2].But there are still many PA patients who are at the early stage of the disease may only be manifested as elevated blood pressure,because of the lack of typical symptoms,such patients were easily missed diagnosis,and would miss the best opportunity for treatment.recent years,more and more studies dose focus on clinical features,pathogenesis of [3],cardiovascular risk factors,target organ damage of PA [1,4-6],but the characteristics of blood pressure,especially the characteristics of ambulatory blood pressure were less reported.Previous studies have shown that the blood pressure characteristics between the secondary hypertension and essential hypertension were different [10],once clinicians can find clues from the patient’s blood pressure,it is possible to achieve early diagnosis and help these patients to reach early treatment.this study was designed to explore the characteristics of ambulatory blood pressure in patients with PA,patients with essential hypertension,and patients with different pathological types of PA.At the same time,primary aldosteronism is the most common cause of secondary hypertension,which may cause serious target organ damage during a short course of disease.Left ventricular hypertroehy is the most common type of target organ damage in hypertension.In many cases,it is also the target organ which was damaged at the earlier time.Recent studies have shown that left remodeling is a pathological condition,which can increase the risk of cardiovascular disease and increase the occurrence of cardiovascular events.And there is a development process of left ventricular remodeling,which can be divided into different types according to the different mechological changes.The studys on the characteristics of left ventricular remodeling in PA patients have showed to be relatively less,so we determine to explore it.【Objective】To investigate the characteristics of blood pressure during daytime,night and all day and the influencing factors of nocturnal hypertension in patients with primary aldosteronism with the new standard at home and abroad.The characteristics of left ventricular remodeling and its influencing factors in patients with primary aldosteronism were also explored.Aiming to deepen the understanding of blood pressure characteristics and left ventricular remodeling in patients with primary aldosterone,and provide reference for targeted treatment and prevention.【Methods】total 246 cases of primary aldosteronism patients in Beijing An Zhen Hospital from 2014 to 2016 were devided into observation group(PA group),All of which were diagnosed in Department of hypertension,comfirmed by surgery in Department of Urology,and verified in in Department of pathology.According to sex,age and body mass index,course of disease,248 cases of primary hypertension patients were choosed as the control group(EH group).Ambulatory blood pressure parameters,including the average level of blood pressure,circadian rhythm and blood pressure variability were compared between the two groups.According to pathological type and single bilateral,ambulatory blood pressure parameters of different pathological types and scope of primary aldosteronism were also compared.comparison PA group and EH group of patients with left ventricular configuration ratio;the PA patients were divided into several groups according to the potassium levels,blood pressure circadian rhythm type,and the parameters of left ventricular structure including ventricular septal thickness(LVST)Left ventricular posterior wall thickness(PWT),left ventricular mass index(LVMI),relative wall thickness(RWT),left ventricular end systolic diameter(LVS),left ventricular end diastolic diameter(LVD)were compared between the groups【Results】(1)The difference of ambulatory blood pressure parameters between PA and EH(1)the level of blood pressure : 24 hours average systolic pressure(24h SBP 135.2±14.8 vs 127.2±15.0),daytime average systolic blood pressure(d SBP 136.7±14.1 vs 129.0±15.1)nocturnal mean systolic blood pressure(n SBP 131.9±16.4 vs 122.3±16.8),24 hour average diastolic pressure(24h DBP 85.7±10.9 vs 78.9±10.6),daytime average diastolic blood pressure(d DBP 87.2±9.8 vs 80.9±10.9)and night diastolic blood pressure(n DBP 81.4±10.5 vs 75.1±11.5)in group PA were significantly higher than that of group EH(P < 0.05)(2)the circadian rhythm : the decline rate of n SBP(3.6(0.0,8.5)vs 6.1(0.9,10.0))was significantly lower in PA group than EH group,but the decline rate of n DBP showed no significant difference(P > 0.05)between the two groups;(3)blood pressure variability: 24 h DBP variation coefficient was significantly lower in PA group than that of EH group(P< 0.05);but the 24 h SBP variation coefficient showed no significant difference(P > 0.05)but between the two groups;(4)the average heart rate: 24 hour average heart rate,average heart rate during the day are significantly lower in PA group than that of EH group(P < 0.05),but the nocturnal mean heart rate showed no significant Difference(P >0.05)between the two groups.(2)According to the diagnostic criteria of ambulatory blood pressure: The incidence of isolated nocturnal hypertension(INH,19.5%vs 8.9%),daytime and nighttime hypertension(DNH 47.2%,vs 14.5%)were significantly higher in PA patients than EH patients(P < 0.05);The incidence of isolated daytime hypertension(IDH 21.1%,vs 66.1%)were significantly lower in PA patients than that of EH patients(P < 0.05);The incidence of normal blood pressure between the two groups(NT 12.2%,vs 10.5%)showed no significant difference(P > 0.05).(3)Analysis of influencing factors of isolate nocturnal hypertension:Age(48.4±10.7 vs 35.1±12.5),Course of disease(12.7±9.5 vs 9.4±5.9),BMI(24.3±3.7 vs 22.1±4.0),NA(142.0±14.5 vs 135.7±12.4),CRP(2.6 ± 0.2 vs 1.8 ± 0.3),Ald(0.15(0.02,0.24)vs0.1(0.08,0.2)),PRA(0.08(0,0.18)vs1.3(0.4,2.6))and Ang II(35(32.2,47.3)vs 44(36.0,64.3))showed significant difference between PA group and EH group(P<0.05).Univariate logistic regression analysis showed:age(OR:1.036,95%CI:1.012-1.051),NA(OR:1.012,95%CI:1.002-1.026),Ald(OR:1.138,95%CI:1.004-2.057),PRA(OR:1.026,95%CI:1.011-1.043)and Ang II(OR:1.028,95% CI: 1.018-1.039)are independent risk factors for isolate nocturnal hypertension in PA patients.Multivariate logistic regression analysis showed :age(OR:1.022,95%CI:1.006-1.043), NA(OR:1.017,95%CI:1.013-1.028),Ald(OR:1.312,95%CI:1.128-1.535),PRA(OR:1.127,95%CI:1.052-1.273)are independent risk factor for PA patients with isolate nocturnal hypertension.(4)PA group and EH group left ventricular configuration comparison: PA group and EH group of patients with left ventricular remodeling type were: normal configuration 40(32.5%)vs 68(54.8%),abnormal configuration 83((8.9%)vs 14(11.3%),concentric hypertroehy18(14.6%)vs 10(8.0%)vs 56(45.2%);),Centrifugal hypertroehy 54(44.0%)vs 31(25.9%).Chi-square test showed that the abnormal configuration rate of PA group was significantly higher than EH group(χ2 = 12.50,P <0.01)(5)Logistic regression analysis showed that independent risk factors of concentric remodeling are: BMI(OR:0.965,95%CI0.928-0.981),serum potassium(OR: 0.946,95%CI: 0.925-0.978),24 h SBP(OR: 1.008,95%CI:1.002-1.016),d SBP(OR:1.024,95%CI:1.012-1.035),n SBP(OR:1.086,95%CI:1.047-1.124).Independent risk factors of concentric hypertrophy are age(OR:1.048,95%CI:1.002-1.083),duration(OR:1.012,95%CI:1.005-1.028),BMI(OR:1.018,95%CI:1.008-1.025),potassium(OR:0.927,95%CI:0.912-0.948),24 h SBP(OR:1.012,95%CI:1.006-1.023),d SBP(OR:1.027,95%CI:1.011-1.042),n SBP(OR:1.126,95%CI:1.094-1.25),n DBP(OR:0.992,95%CI: 0.889-1.086).Independent risk factors of eccentric hypertrophy:age(OR:1.027,95%CI:1.004-1.036),duration(OR:1.010,95%CI:1.007-1.0 26),potassium(OR:0.950,95%CI:0.927-0.994),24 h SBP(OR: 1.026,95%CI:1.008-1.037),d SBP(OR:1.007,95%CI:1.002-1.016),n SBP(OR:1.052,95%CI: 1.017-1.098).【Conclusion】1、The daytime,night time and 24 hour average blood pressure levels were significantly higher in PA patients than in EH patients,24 h SBP and n DBP blood pressure variability is also larger than EH patients,the systolic blood pressure circadian rhythm abnormality rate was significantly higher than that in EH patients,but no significant difference in diastolic blood pressure circadian rhythm.2、The incidence of isolate nocturnal hypertension and day-night sustained hypertension are significantly higher in PA patients than in EH patients;the incidence of isolate daytime hypertension was significantly lower than that in EH patients with;the incidence of normal blood pressure was not significant different from that of EH patients.3、The incidence of nocturnal hypertension in PA patients was associated with renin-angiotensin-aldosterone system,serum sodium concentration,and age.Combineing ACEI/ARB drugs with low salt diet may have a better effect on treatment.4、The incidence of left ventricular geometry was significantly higher in PA patients than in EH patients,but there was no significant difference in the incidence of concentric remodeling,concentric hypertrophy and eccentric hypertrophy.5、 Different kind of left ventricular remodeling in patients with PA showed differen risk factors,systolic blood pressure,nocturnal mean systolic blood pressure and serum potassium levels 、OSAHS、CKD were the common factors.