We investigated exercise induced urinary albuminThe three groups did not differ in 24 h UAE. Exercise excretion rate (UAE) (ex-UAE) in patients with borderline induced a significant increase in UAE only in BH. Exerhypertension (

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We report a case of a 41-year-old man who was noted to have position-dependent Cheyne-Stokes respiration with central sleep apnea (CSA) during sleep. The patient had multiple cardiovascular risk factors and target organ damages, including a history of two myocardial infarctions, transient ischemic attack, and chronic kidney disease. His hypertension was refractory to a number of antihypertensive medicines, however, a complete elimination of sleep-disordered breathing with oral theophylline treatment was paralleled by a signifi cant BP fall with a subsequent need for reduction of antihypertensive drugs. Following these surprising observations we decided to withdraw theophylline from treatment (in-clinic). Theophylline discontinuation resulted in a gradual increase in BP and an urgent call for antihypertensive treatment modifi cation. These observations suggest a potent hypotensive action of oral theophylline via CheyneStokes respiration with CSA elimination. Our data suggest that CSA may be a mechanism that raises BP even during the daytime. CHEST 2014; 146 ( 1 ): e8 -e10Abbreviations : AHI 5 apnea-hypopnea index ; CSA 5 central sleep apnea ; CSR 5 Cheyne-Stokes respiration ; LVEF 5 left ventricular ejection fraction ; Sp o 2 5 oxygen saturation by pulse oximetry ; TIA 5 transient ischemic attack C heyne-Stokes respiration (CSR) with central sleep apnea (CSA) is frequently encountered in pathologic conditions (eg, neurologic dysfunction or congestive heart failure), where it may be implicated in increased morbidity and mortality. 1 -3 Although sleep apnea has been linked to arterial hypertension, only the obstructive type of sleep apnea, and not CSA, is believed to be a causative factor in developing hypertension. 4 -6 In this case report, we show that attenuation of CSR-CSA during sleep with oral theophylline treatment in a patient with hypertensive heart failure (left ventricular ejection fraction [LVEF] 5 45%) signifi cantly improved BP control. Case ReportA 41-year-old man with a longstanding history of complicated, essential hypertension refractory to seven antihypertensives was noted to have CSR-CSA during sleep ( Fig 1 ), exclusively in the supine position. His BP control was poor and showed measurements up to 280/180 mm Hg on home and offi ce measurements and up to 200/140 mm Hg without nocturnal BP dip on 24-h ambulatory BP. The patient had an atherogenic lipid profi le, was overweight (BMI 5 28), smoked cigarettes, frequently drank alcohol to excess, and had a strong family history of cardiovascular disease. He had left ventricle hypertrophy with segmental contractility impairment, a history of two non-ST segment elevation myocardial infarctions, transient ischemic attack (TIA), retinopathy, and chronic kidney disease (plasma creatinine level, 150 m mol/L). The patient was free of diabetes mellitus. Several forms of secondary hypertension (renovascular, hormonal, vasculitis) as well as noncompliance with medications were excluded. Sleep-Related HistoryDespite poor sleep quality for approximately 20 yea...

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