Masked arterial hypertension in a 64-year-old man with primary aldosteronism
Purpose Primary aldosteronism is one of the most frequent causes of secondary arterial hypertension, and whether primary aldosteronism is associated with masked hypertension is unknown. Materials and methods We describe a 64-year-old man with a history of hypothyroidism, recurring hypokalaemia, and...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-12-01
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| Series: | Blood Pressure |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/08037051.2021.2003699 |
| _version_ | 1797676862026022912 |
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| author | Joanna Kanarek-Kucner Beata Graff Vlasta Bari Rufus Barraclough Krzysztof Narkiewicz Michał Hoffmann |
| author_facet | Joanna Kanarek-Kucner Beata Graff Vlasta Bari Rufus Barraclough Krzysztof Narkiewicz Michał Hoffmann |
| author_sort | Joanna Kanarek-Kucner |
| collection | DOAJ |
| description | Purpose Primary aldosteronism is one of the most frequent causes of secondary arterial hypertension, and whether primary aldosteronism is associated with masked hypertension is unknown. Materials and methods We describe a 64-year-old man with a history of hypothyroidism, recurring hypokalaemia, and normal home and office blood pressure values. Ambulatory blood pressure monitoring revealed masked hypertension with strikingly high systolic blood pressure variability and typical hypertension-mediated organ damage. Results The patient required gradual escalation of antihypertensive medication to four drugs. During the diagnostic process we identified primary aldosteronism, cobalamin deficiency, severe obstructive sleep apnoea, and low baroreflex sensitivity (1.63 ms/mmHg). Following unilateral adrenalectomy, cobalamin supplementation and continuous positive airway pressure, we observed a spectacular improvement in the patient’s blood pressure control, baroreflex sensitivity (4.82 ms/mmHg) and quality of life. Conclusions We report an unusual case of both masked arterial hypertension and primary aldosteronism. Elevated blood pressure values were masked in home and office measurements by coexisting hypotension which resulted most probably from deteriorated baroreflex sensitivity. Baroreflex sensitivity increased following treatment, including unilateral adrenalectomy. Hypertension can be masked by coexisting baroreceptor dysfunction which may derive from structural but also functional reversible changes. |
| first_indexed | 2024-03-11T22:35:34Z |
| format | Article |
| id | doaj.art-150ee4c7c55944938ee91a5a9ec01982 |
| institution | Directory Open Access Journal |
| issn | 0803-7051 1651-1999 |
| language | English |
| last_indexed | 2024-03-11T22:35:34Z |
| publishDate | 2022-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Blood Pressure |
| spelling | doaj.art-150ee4c7c55944938ee91a5a9ec019822023-09-22T13:54:18ZengTaylor & Francis GroupBlood Pressure0803-70511651-19992022-12-013114810.1080/08037051.2021.20036992003699Masked arterial hypertension in a 64-year-old man with primary aldosteronismJoanna Kanarek-Kucner0Beata Graff1Vlasta Bari2Rufus Barraclough3Krzysztof Narkiewicz4Michał Hoffmann5Department of Pathology and Experimental Rheumatology, Medical University of GdańskDepartment of Hypertension and Diabetology, Medical University of GdańskLaboratory of Complex Systems Modeling, IRCCS Policlinico San DonatoSTRIVE Academic Centre, Friarage HospitalDepartment of Hypertension and Diabetology, Medical University of GdańskDepartment of Hypertension and Diabetology, Medical University of GdańskPurpose Primary aldosteronism is one of the most frequent causes of secondary arterial hypertension, and whether primary aldosteronism is associated with masked hypertension is unknown. Materials and methods We describe a 64-year-old man with a history of hypothyroidism, recurring hypokalaemia, and normal home and office blood pressure values. Ambulatory blood pressure monitoring revealed masked hypertension with strikingly high systolic blood pressure variability and typical hypertension-mediated organ damage. Results The patient required gradual escalation of antihypertensive medication to four drugs. During the diagnostic process we identified primary aldosteronism, cobalamin deficiency, severe obstructive sleep apnoea, and low baroreflex sensitivity (1.63 ms/mmHg). Following unilateral adrenalectomy, cobalamin supplementation and continuous positive airway pressure, we observed a spectacular improvement in the patient’s blood pressure control, baroreflex sensitivity (4.82 ms/mmHg) and quality of life. Conclusions We report an unusual case of both masked arterial hypertension and primary aldosteronism. Elevated blood pressure values were masked in home and office measurements by coexisting hypotension which resulted most probably from deteriorated baroreflex sensitivity. Baroreflex sensitivity increased following treatment, including unilateral adrenalectomy. Hypertension can be masked by coexisting baroreceptor dysfunction which may derive from structural but also functional reversible changes.http://dx.doi.org/10.1080/08037051.2021.2003699masked arterial hypertensionprimary aldosteronismbaroreflex dysfunctionobstructive sleep apnoeacobalamin deficiency |
| spellingShingle | Joanna Kanarek-Kucner Beata Graff Vlasta Bari Rufus Barraclough Krzysztof Narkiewicz Michał Hoffmann Masked arterial hypertension in a 64-year-old man with primary aldosteronism Blood Pressure masked arterial hypertension primary aldosteronism baroreflex dysfunction obstructive sleep apnoea cobalamin deficiency |
| title | Masked arterial hypertension in a 64-year-old man with primary aldosteronism |
| title_full | Masked arterial hypertension in a 64-year-old man with primary aldosteronism |
| title_fullStr | Masked arterial hypertension in a 64-year-old man with primary aldosteronism |
| title_full_unstemmed | Masked arterial hypertension in a 64-year-old man with primary aldosteronism |
| title_short | Masked arterial hypertension in a 64-year-old man with primary aldosteronism |
| title_sort | masked arterial hypertension in a 64 year old man with primary aldosteronism |
| topic | masked arterial hypertension primary aldosteronism baroreflex dysfunction obstructive sleep apnoea cobalamin deficiency |
| url | http://dx.doi.org/10.1080/08037051.2021.2003699 |
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