A prospective analysis of 681 patients with confirmed primary aldosteronism (PA) demonstrated an inverse, dose‑dependent relationship between aldosterone excess and impairment of nocturnal blood pressure (BP) dipping. In multivariable models, higher log plasma aldosterone concentration and higher log aldosterone-to-renin ratio independently correlated with a smaller proportion of nocturnal systolic BP decline (β = −0.054, 95% CI −0.087 to −0.020, P = 0.002; and β = −0.016, 95% CI −0.025 to −0.006, P = 0.001, respectively).
Among 99 patients with unilateral PA confirmed by adrenal venous sampling who underwent targeted aldosterone suppression, those achieving biochemical remission showed a significant nocturnal BP decrease (mean −33 mm Hg; Cohen’s d_z = 2.113) and an increase in dipper pattern prevalence from 14.5% to 39.1% (P < 0.001). Nonresponders did not exhibit rhythm improvement.
Multivariable regression indicated that biochemical success independently predicted enhancement of nocturnal dipping (P = 0.045), irrespective of imaging phenotype. Conclusion: Aldosterone excess is linked to disrupted circadian BP rhythm in PA.
Selective hormonal suppression can improve nocturnal dipping in biochemical responders, underscoring rhythm‑oriented endpoints in PA management.
Journal of the American Heart Association published a clinical update in Cardiology on 10 Mar 2026.
The item focuses on Aldosterone and Impaired Nocturnal Blood Pressure Decline in Primary Aldosteronism.
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