EVALUATION OF CENTRAL BLOOD PRESSURE IN PRIMARY ALDOSTERONISM AND PRIMARY HYPERTENSION: IS THERE A DIFFERENCE?

Objective: Central Blood Pressure (CBP) differs from peripheral BP (BP) and represents the pressure to which vital organs and vessels prone to atherosclerosis are exposed. Although the use of CBP in clinical settings is not usually recommended, some studies have shown it may play a role in cardiovascular risk assessment. In this study, we compared patients with primary aldosteronism, a secondary form of hypertension, to those with primary hypertension, aiming to identify possible differences in systolic CBP values. Design and method: We conducted a case-control study in a sample of hypertensive patients recruited from Verona ESH Centre. CBP and vascular stiffness were assessed noninvasively from peripheral BP waveforms, using tonometry and cuff-based devices (SphygmoCor XCel). Twenty patients diagnosed with primary aldosteronism (48.9 ± 11.7; 11 males) were matched, by sex and age (±5 years), with 20 controls (45.5 ±13.6; 8 males), affected by Primary Hypertension. Results: Systolic CBP was significantly higher in patients with primary aldosteronism (132± 13.5 mmHg vs 123± 8.92 mmHg), despite no difference in peripheral BP (139± 14.5 mmHg vs 135± 11.6 mmHg) receiving a significantly higher number of antihypertensive drugs (n=2.2 ± 1.11 vs n=1.4 ± 1.1). Moreover, linear regression confirmed the association between Systolic CBP and the diagnosis of primary aldosteronism (beta 0.575, 95% CI 0.15-0.99; p=0.009), after adjustment for age, sex, number of antihypertensive drugs, body mass index (BMI). No statistically significant difference was observed in intima-media thickness, vascular distensibility and PWV between the two groups. Conclusions: In this sample of patients with primary aldosteronism Systolic CBP (but not peripheral BP) was higher compared to those with primary hypertension, despite the use of more anti-hypertensive drugs. This finding suggests that CBP may be a more reliable indicator of the well-known increase in Hypertensive-mediated organ damage observed in these patients. Further studies are needed to confirm this observation, to investigate other forms of secondary hypertension, and to eventually establish CBP potential role in clinical practise and cardiovascular risk assessment.