Association of aldosterone excess and apnea-hypopnea index in patients with resistant hypertension

Ke, Xiaoyan; Guo, Wei; Hu, Peng; Zhang, Henghong; Peng, Changnong; Wang, Xiaoqing

doi:10.1038/srep45241

Cited by 26 publications

(22 citation statements)

References 28 publications

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“…A common cause of RHTN is hyperaldosteronism [35] and several studies have shown a link between high plasma aldosterone concentration and the severity of OSA [36,37]. This can, in part, explain the high prevalence of OSA in RHTN patients.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Effects of Continuous Positive Airway Pressure (CPAP) Therapy on Obesity and Cardiovascular Comorbidities in Patients with Obstructive Sleep Apnea and Resistant Hypertension—An Observational Study

Pleavă

Mihăicuţă

Serban

et al. 2020

JCM

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Background: We sought to investigate whether long-term continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA) and resistant hypertension (RHTN) could attenuate the cardiovascular disease risk by lowering their body-mass index (BMI). Methods: This was a long-term observational study of RHTN patients diagnosed with OSA. Patients were evaluated with polysomnography initially and after a mean follow-up period of four years. The patients were divided into two groups based on their compliance to CPAP therapy. Results: 33 patients (aged 54.67 ± 7.5, 18 men, 54.5%) were included in the study, of which 12 were compliant to CPAP therapy. A significant reduction in BMI at follow-up was noted in patients compliant to CPAP therapy (1.4 ± 3.5 vs. −1.6 ± 2.5, p = 0.006). We also noted a large effect size reduction in abdominal circumference at follow-up in the CPAP group. At follow-up evaluation, the mean heart rate (b/min) was lower in the CPAP group (58.6 ± 9.5 vs. 67.8 ± 7.8), while arrhythmia prevalence increased between initial (28.6%) and follow-up (42.9%) evaluation with an intermediate effect size in non-compliant patients. Conclusions: In our cohort of OSA patients with RHTN, long-term adherence to CPAP therapy was associated with weight loss and improvement in cardiac rhythm outcomes.

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Section: Discussionmentioning

confidence: 99%

Long-Term Effects of Continuous Positive Airway Pressure (CPAP) Therapy on Obesity and Cardiovascular Comorbidities in Patients with Obstructive Sleep Apnea and Resistant Hypertension—An Observational Study

Pleavă

Mihăicuţă

Serban

et al. 2020

JCM

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“…There are also intriguing recent reports on the potential role of mineralcorticoid hormones, in particular of aldosterone, in the relationship between OSA and hypertension, Aldosterone is a hormone produced by the outer portion (cortex) of the adrenal gland and is involved in the regulation of water and electrolytes balance in the body. Among patients with resistant hypertension, the occurrence of hyperaldosteronism is significantly associated with the prevalence and severity of OSA (25). In fact, treatment with aldosterone antagonists can reduce not only BP levels, but also the severity of OSA (26).…”

Section: Hormonal and Inflammatory Changesmentioning

confidence: 99%

Systemic hypertension in obstructive sleep apnea

Lombardi¹,

Pengo²,

Parati³

2018

J. Thorac. Dis

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There is consistent epidemiological evidence that sleep disordered breathing and systemic arterial hypertension are deeply associated, being linked through a bidirectional complex interaction among multiple mechanisms including autonomic nervous system alterations, inflammation, hormonal and hemodynamic components, sleep alterations. However there are several unanswered questions not only from a pathophysiological perspective, but also regarding the effects of obstructive sleep apnea (OSA) treatment on arterial blood pressure values. At present, while many studies have supported the possibility to obtain at least a small blood pressure reduction with OSA treatment, in particular in hypertensive patients, large trials have not clearly confirmed a significant anti-hypertensive effect, nor a beneficial effect of this intervention on cardiovascular endpoints including cardiovascular mortality. Aim of the present review article is to address the relationship between OSA and hypertension in the light of the latest evidence in the field. Moreover we will discuss research topics which need to be investigated in the future, in order to better clarify still pending issues with the aim of obtaining an early diagnosis, a more suitable phenotyping including comorbidities, and better strategies to improve patients' compliance and adherence to treatment.

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“…High aldosterone secretion increases the retention of sodium and water in the kidneys and is related to the severity of obstructive sleep apnea and blood pressure level 24, 26, 27. Hypertension in women is more sensitive to sodium intake than in men 27.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial

Rietz

Franklin

Carlberg

et al. 2018

JAHA

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BackgroundObstructive sleep apnea is associated with high blood pressure. The magnitude of blood pressure effects from sleep apnea treatment is unclear. We aimed to determine the effect of mandibular advancement device therapy on ambulatory nighttime and daytime blood pressure in women and men with daytime sleepiness and snoring or mild to moderate sleep apnea (apnea‐hypopnea index, <30).Methods and ResultsIn this 4‐month, double‐blind, randomized controlled trial comprising 96 untreated patients, 27 women and 58 men, aged 31 to 70 years, completed the study. The active group received individually made adjustable mandibular advancement devices, and the control group was given individually made sham devices, to be used during sleep. Polysomnographic sleep recordings and ambulatory 24‐hour blood pressure measurements were performed at baseline and at follow‐up. In women with mandibular advancement devices, the mean nighttime systolic blood pressure was 10.8 mm Hg (95% confidence interval, 4.0–17.7 mm Hg; P=0.004) lower than in the women in the sham group, adjusted for baseline blood pressure, age, body mass index, and the apnea‐hypopnea index. The mean nighttime adjusted diastolic blood pressure was 6.6 mm Hg (95% confidence interval, 2.7–10.4 mm Hg; P=0.002) lower in the mandibular advancement device group. In men, there were no significant differences in blood pressure at night or during the daytime between the intervention groups.ConclusionsA mandibular advancement device for obstructive sleep apnea reduces nocturnal blood pressure in women.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00477009.

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Association of aldosterone excess and apnea-hypopnea index in patients with resistant hypertension

Cited by 26 publications

References 28 publications

Long-Term Effects of Continuous Positive Airway Pressure (CPAP) Therapy on Obesity and Cardiovascular Comorbidities in Patients with Obstructive Sleep Apnea and Resistant Hypertension—An Observational Study

Long-Term Effects of Continuous Positive Airway Pressure (CPAP) Therapy on Obesity and Cardiovascular Comorbidities in Patients with Obstructive Sleep Apnea and Resistant Hypertension—An Observational Study

Systemic hypertension in obstructive sleep apnea

Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial

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