Ambulatory Blood Pressure In Primary Aldosteronism Retrospective Analysis Of Cha Racteristics And Target Organ Damage

Objective Primary aldosteronism(PA)is one of the common secondary hypertension.Compared with essential hypertension(EH),PA is more prone to cardiovascular and cerebrovascular complications.In this study,we retrospectively analyzed the characteristics of ambulatory blood pressure and target organ damage in PA patients,so as to deepen the understanding of the characteristics of blood pressure and target organ damage in PA patients.Methods The study population consisted of 395 patients who were hospitalized for the first time in the hypertensive area of the First Affiliated Hospital of Guangxi Medical University from 2016 to 2018.There were 100 patients with PA and 295 patients with EH.PA patients were divided into aldosterone producing adenoma(APA)group and idiopathic hyperaldosteronism(IHA)group for subgroup analysis based on adrenal CT findings and subarachnoid venous blood sampling(AVS)results(APA).57 patients in the group and 43 patients in the IHA group).Collect all the selected subjects’ age,gender,disease duration,body mass index(BMI),ambulatory blood pressure monitoring(ABPM),clinical comorbidities,etc.;detect total cholesterol(TC),homocysteine(Homocysteine,Hcy),serum potassium,blood sodium,uric acid(UA),creatinine(Cr),fasting plasma glucose(FPG),glycosylated hemoglobin(HbAlC),ortho-aldosterone concentration(Plasma aldosterone concentration,PAC),plasma renin activity(PRA),angiotensin II(angiotensin II,All),urinary microalbumin/creatinine,24-hour urine protein,24-hour urine microalbumin;The pulse wave velocity(PWV),the ankle arm index(ABI),and the augmentation index(AI)were measured by an arteriosclerometer.Carotid intima thickness was measured by cervical vascular ultrasound.Left ventricular interventricular septal thickness(LVST),left ventricular posterior wall thickness(LVPWT),left ventricular ejection fraction(EF),and left ventricular mass were measured by transthoracic echocardiography.Left ventricular mass index(LVMI).The data were compared and analyzed by t test,non-parametric test andχ2 test.The dynamic blood pressure characteristics and target organ damage between PA and EH,APA and IHA were compared.Statistical analysis was performed using SPSS 22.0.Results(1)The BMI,serum potassium,Hcy,standing PRA and AII in the PA group were lower than those in the EH group(P<0.05).The standing PAC and the serum sodium PA group were significantly higher than the EH group(P<0.01).There was no significant difference in age,course of disease,UA,TC,FPG and HbA1 between the PA group and the EH group(P>0.05).There was no significant difference between the PA group and the EH group(P>0.05).(2)The 24-hour mean systolic blood pressure,24-hour mean diastolic blood pressure,mean daytime systolic blood pressure,daytime mean diastolic blood pressure,nighttime mean systolic blood pressure,nocturnal mean diastolic blood pressure,and sleep-Guchenfeng blood pressure in the PA group were not significantly different from those in the EH group.(P>0.05).(3)The scoop rate of the PA group was lower than that of the EH group(15%vs 34.6%),and the non-spoon rate was higher than that of the EH group(66%vs 51.9%).The difference was statistically significant(P<0.05).There was no significant difference between the anti-dope rate and the super-spoon rate(15%vs 12.2%,4%vs 1.3%)in the EH group(P>0.05).(4)There was no significant difference in PWV,AI and ABI between PA group and EH group(P>0.05).(5)The eGFR of the PA group was lower than that of the EH group,and the difference was statistically significant(P<0.01).There was no significant difference in urine microalbumin/creatinine ratio,24-hour urine microalbumin,Cr,24-hour urine protein(P>0.05).(6)There was no significant difference in LVST,LVPWT,EF and LVMI between PA group and EH group(P>0.05).(7)Subgroup analysis:The low potassium rate and HbA1 in the APA group were significantly greater than those in the IHA group(P<0.05),age,duration,BMI,serum potassium,blood sodium,Hcy,PAC,PRA,All in the APA group and the IHA group.The difference was not statistically significant(P>0.05).There was no significant difference in the comorbidities between the APA group and the IHA group(P>0.05).(8)24 hours mean systolic blood pressure,24-hour mean diastolic blood pressure,mean daytime systolic blood pressure,daytime mean diastolic blood pressure,nighttime mean systolic pressure,nocturnal mean diastolic blood pressure,and sleep-Guchenfeng blood pressure were not statistically different from those in the IHA group.Significance(P>0.05).(9)The scoop rate of APA group was higher than that of IHA group(22.8%vs 7%),and the rate of non-spoon rate,reverse spoon rate and super spoon type were lower than IHA group(63.2%vs65.0%,10.5%).Vs 23.3%,3.5%vs 4.7%),but the difference was not statistically significant(P>0.05).(10)There was no significant difference in PWV,AI,ABI and carotid intima thickening rate between the APA group and the IHA group(P>0.05).(11)Urinary microalbumin/creatinine ratio and 24-hour urine microalbumin were higher in APA group than in IHA group(P<0.05).There was no significant difference between Cr and 24-hour urine protein groups(P>0.05)..(12)The LVST,LVPWT,EF and LVMI of the APA group were higher than those of the IHA group.There was no significant difference between the two groups(P>0.05).Conclusions 1.The rate of non-drafting of blood pressure rhythm in patients with PA is higher than that in patients with EH.2.Patients with PA are more likely to cause renal damage than EH.APA is more pronounced in kidney damage than IHA.3.APA has a higher incidence of hypokalemia than IHA,and may be more likely to have abnormal glucose metabolism.