American journal of hypertension · 2026
Association between plasma aldosterone after saline infusion test and nocturnal hypertension in patients with suspected primary aldosteronism.
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Wang Lulu, Tian Gang, Liu Xiaozhuan, Qu Huiyun, Du Huiyu, Liu Pian, Chen Jiaxuan, Sun Tingxi, Zhang Chen, Sun Jialin, Xie Junpeng, Tian Dandan, Dong Wenyong, Hao Yibin, Liu Min
Аннотация
BACKGROUND: Nocturnal hypertension (NH) is a significant risk factor for target organ damage and all-cause mortality. Post-saline infusion test plasma aldosterone concentration (post-SIT PAC) serves as an indicator of autonomous aldosterone secretion level, but its link to NH is uncertain. This study aims to explore the association between post-SIT PAC levels and NH in patients with suspected primary aldosteronism (PA).
METHODS: Participants were classified into 3 groups after a saline infusion test (SIT): negative (post-SIT PAC < 5 ng/dL, n = 86), borderline (post-SIT PAC 5-10 ng/dL, n = 180), and positive (post-SIT PAC > 10 ng/dL, n = 75). Restricted cubic spline (RCS) plots were used to explore the dose-response relationship between post-SIT PAC and NH, while multivariable logistic regression models adjusted for potential confounders.
RESULTS: In this retrospective study, the overall prevalence of NH was 70.4%. A positive, nonlinear association was identified between post-SIT PAC and NH (P-nonlinear <.05). After adjustment for multiple variables, post-SIT PAC remained significantly correlated with NH (OR = 1.08; 95% CI: 1.01-1.15; P < .05), while basal PAC was not. Additionally, guideline-defined subgroups with elevated post-SIT PAC demonstrated a higher prevalence of NH (P < .05). Specifically, NH prevalence was 81.3% (n = 75) in the positive subgroup, 72.2% (n = 180) in the borderline subgroup, and 57.0% (n = 86) in the negative subgroup.
CONCLUSIONS: The level of autonomous aldosterone secretion, rather than the basal aldosterone level, is relevant to potential PA patients at risk for NH. NH prevalence increases nonlinearly with higher post-SIT PAC levels.
METHODS: Participants were classified into 3 groups after a saline infusion test (SIT): negative (post-SIT PAC < 5 ng/dL, n = 86), borderline (post-SIT PAC 5-10 ng/dL, n = 180), and positive (post-SIT PAC > 10 ng/dL, n = 75). Restricted cubic spline (RCS) plots were used to explore the dose-response relationship between post-SIT PAC and NH, while multivariable logistic regression models adjusted for potential confounders.
RESULTS: In this retrospective study, the overall prevalence of NH was 70.4%. A positive, nonlinear association was identified between post-SIT PAC and NH (P-nonlinear <.05). After adjustment for multiple variables, post-SIT PAC remained significantly correlated with NH (OR = 1.08; 95% CI: 1.01-1.15; P < .05), while basal PAC was not. Additionally, guideline-defined subgroups with elevated post-SIT PAC demonstrated a higher prevalence of NH (P < .05). Specifically, NH prevalence was 81.3% (n = 75) in the positive subgroup, 72.2% (n = 180) in the borderline subgroup, and 57.0% (n = 86) in the negative subgroup.
CONCLUSIONS: The level of autonomous aldosterone secretion, rather than the basal aldosterone level, is relevant to potential PA patients at risk for NH. NH prevalence increases nonlinearly with higher post-SIT PAC levels.