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Circadian variations of plasma atrial natriuretic peptide in four types of hypertensive disorder during pregnancy

Summary. Circadian variations in plasma atrial natriuretic peptide were studied, to clarify the characteristic pathophysiology of pregnancy‐induced hypertension (PIH). The mean 24‐h values (range) of atrial natriuretic peptide in mild and severe PIH, pregnancy‐aggravated hypertension, chronic hypertension and normal pregnancy were 130·1 (97·3−207·0), 225·4 (202·8−281·8), 213·1 (183·2−249·5), 81·3 (61·8−116·1) and 77·1 (56·0−123·5) pg/ml, respectively. The values in PIH and pregnancy‐aggravated hypertension were significantly higher, although those in chronic hypertension were no different from normal pregnancy. Plasma atrial natriuretic peptide showed a clear circadian rhythm with acrophase in the middle of the night, in mild and severe PIH. In the other hypertensive disorders, a circadian rhythm could not be confirmed. The results indicate that the elevated values of plasma atrial natriuretic peptide in hypertensive disorders during pregnancy relate to generalized vasoconstriction, and that the diurnal rhythm is a specific characteristic of PIH.