Masked arterial hypertension in a 64-year-old man with primary aldosteronism

Figures & data

Table 1. Patient’s test results.

Parameter	Unit	Normal range	Result
Blood sodium	mmol/l	136–145	144
Blood potassium	mmol/l	3.5–5.1	3.4
24-hours urinary sodium excretion	mmol/24h	40–220	149
24-hour urinary potassium excretion	mmol/24h	25–125	63
Red cell count	x10^12/l	4.5–5.5	3.97
Haemoglobin	g/dl	13–17	11.2
Mean Corpuscular Volume	fl	80–96	83
White cell count	x10^9/l	2–7	5.16
Platelet count	x10^9/l	150–410	195
Vitamin B12	pg/ml	189–883	168
Iron	μg/dl	65–175	122
Folic acid	ng/ml	3.1–20.5	3.8
Ferritin	ng/ml	22–275	45
Thyroid Stimulating Hormone	μU/ml	0.34–4.94	0.9
Fasting blood glucose	mg/dl	70–99	89
Baseline aldosterone	ng/dl	1.76–23.2	17.9
Baseline renin plasma	μlU/ml	2.8–39.9	<2

Table 2. Ambulatory blood pressure monitoring results.

Treatment period	Assessment date	Antihypertensive medication	Ambulatory blood pressure monitoring values
			24-hours												day												night
			Systolic blood pressure				Diastolic blood pressure				Heart rate				Systolic blood pressure				Diastolic blood pressure				Heart rate				Systolic blood pressure				Diastolic blood pressure				Heart rate
			mean	Standard deviation	min.	max.	mean	Standard deviation	min.	max.	mean	Standard deviation	min.	max.	mean	Standard deviation	min.	max.	mean	Standard deviation	min.	max.	mean	Standard deviation	min.	max.	mean	Standard deviation	min.	max.	mean	Standard deviation	min.	max.	mean	Standard deviation	min.	max.
before adrenalectomy	13/04/2016	no treatment	157	43.0	70	217	93	19.3	44	119	72	8.2	61	92	146	43.8	70	217	88	20.1	44	119	74	7.7	62	92	189	9.7	169	200	106	3.1	101	110	64	1.4	61	66
	25/04/2016	valsartan 160mg spironolactone 25mg	156	34.3	74	208	96	17.5	44	116	79	8.7	65	104	147	34.7	74	203	93	18.7	44	113	81	8.9	65	104	181	16.5	143	208	105	8.8	82	116	74	5.3	66	81
	22/08/2016	valsartan 320mg spironolactone 50mg nebivolol 5mg	146	26.3	89	188	91	13.4	50	110	73	6.1	64	92	142	26.9	89	188	89	13.7	50	107	73	6.3	64	92	160	20.6	109	187	98	9.6	75	110	73	5.6	65	86
	20/10/2016	valsatran 320mg spironolactone 75mg nebivolol 5mg amlodipine 5mg	133	23.5	75	169	86	13.6	40	104	75	7.2	60	88	131	24.7	75	169	84	14.4	40	103	76	7.6	60	88	143	14.8	120	165	92	6.9	81	104	75	4.7	69	83
after adrenalectomy	24/04/2017 (3 months after adrenalectomy)	nebivolol 2.5mg	125	23.0	73	158	79	13.5	41	100	72	5.7	58	90	122	23.8	73	158	77	14.3	41	100	71	6.7	58	90	128	21.5	92	157	82	11.4	58	96	73	3.1	67	76
	18/12/2017 (10 months after adrenalectomy)	nebivolol 2.5mg	129	23.7	82	172	84	14.4	54	107	77	9.4	61	101	119	20.7	82	164	78	13.4	54	100	79	8.8	64	96	152	15.7	116	172	97	7.0	80	107	72	9.9	61	101

Figure 1. Primary aldosteronism diagnostic pathway in described case.