Plasma Aldosterone Is Related to Severity of Obstructive Sleep Apnea in Subjects With Resistant Hypertension

Pratt-Ubunama, Monique N.; Nishizaka, Mari K.; Boedefeld, Robyn L.; Cofield, Stacey S.; Harding, Susan M.; Calhoun, David A.

doi:10.1378/chest.06-1442

Cited by 290 publications

(203 citation statements)

References 33 publications

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“…82 A positive correlation also has been reported between aldosterone and OSA severity, but this correlation was true only for patients with resistant hypertension and was not evident in normotensive controls. 83 …”

Section: Vasoactive Substancesmentioning

confidence: 99%

“…Increased aldosterone has been suggested as a possible contributor to resistant hypertension in sleep apnea. 83,147,148 The weight of evidence has led the most recent Joint National Committee on the Detection and Management of Hypertension to identify OSA as an important identifiable cause of hypertension. 149 …”

Section: Osa and The Origin And Progression Of Hypertensionmentioning

confidence: 99%

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Sleep Apnea and Cardiovascular Disease

et al. 2008

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Section: Vasoactive Substancesmentioning

confidence: 99%

Section: Osa and The Origin And Progression Of Hypertensionmentioning

confidence: 99%

Sleep Apnea and Cardiovascular Disease

et al. 2008

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“…13 The incidence of eccentric cardiomegaly has been reported to be elevated in OSAS patients with left ventricular anomaly. 14 A number of reports have shown that OSAS patients show decreased serum levels of adiponectin because of increased sympathetic nervous activity, 15 insulin resistance, 16 activity of the reninangiotensin-aldosterone (RAA) system 17 and production of vasopressor hormones, and these changes are involved in the elevation of BP in OSAS patients. Plasma levels of endothelin-1 during the night in OSAS patients are increased in relation to BP and the severity of OSAS.…”

Section: Mechanism Underlying the Link Between Hypertension And Osasmentioning

confidence: 99%

Obstructive sleep apnea syndrome and hypertension: mechanism of the linkage and 24-h blood pressure control

Kario

2009

Hypertens Res

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Hypertensive patients with obstructive sleep apnea syndrome (OSAS) constitute a high-risk group for metabolic syndrome. OSAS directly induces negative intrathoracic pressure and decreases pulmonary stretch receptor stimulation, chemoreceptor stimulation, hypoxemia, hypercapnia and microarousal. These changes potentiate various risk factors, including the sympathetic nervous system, renin-angiotensin-aldosterone system and inflammation. Early detection and treatment of OSAS in asymptomatic hypertensive patients is essentially important to prevent hypertensive target organ damage and subsequent cardiovascular events. Continuous positive airway pressure (CPAP) therapy, a first-line treatment in hypertensive patients with moderate to severe OSAS, reduces ambulatory BP level, particularly during the sleep period, and midnight BP surge. However, individual differences in the BP-lowering effect of CPAP have been observed. OSAS hypertensive patients who do not tolerate CPAP remain at a high risk for cardiovascular disease because of negative intrathoracic pressure and need more aggressive antihypertensive treatment to achieve 24-h BP control with nocturnal BP o120/70 mm Hg.

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“…Aldosterone is also part of the RAS, and specific blockade of aldosterone should be considered in certain settings. Recent studies suggest that adding spironolactone or eplerenone to existing antihypertensive regimens for patients with resistant hypertension who are obese or have sleep apnea provides significant BP reduction [11,73]. For 76 patients with uncontrolled BP taking an average of 4 antihypertensive medications, the addition of spironolactone (12.5 to 25 mg daily) resulted in an average 25/12 mm Hg reduction after 6 months [74].…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Resistant hypertension: Definition, evaluation, and new therapeutic approaches to treatment

Rosa¹

2017

Dis Disord

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Resistant hypertension is defined as blood pressure above the patient's goal despite the use of 3 or more antihypertensive agents from different classes at optimal doses, one of which should ideally be a diuretic. Although the exact prevalence of resistant hypertension is currently unknown, indirect evidence from population studies and clinical trials suggests that it is a relatively common clinical problem. The prevalence of resistant hypertension is projected to increase, owing to the aging population and increasing trends in obesity, sleep apnea, and chronic kidney disease. Evaluation of patients with resistive hypertension should first confirm that they have true resistant hypertension by ruling out or correcting factors associated with pseudoresistance such as white coat hypertension, suboptimal blood pressure measurement technique, poor adherence to prescribed medication, suboptimal dosing of antihypertensive agents or inappropriate combinations, the white coat effect, and clinical inertia. Management includes lifestyle and dietary modification, elimination of medications contributing to resistance, and evaluation of potential secondary causes of hypertension. Education and reinforcement of life-style issues that affect BP, such as sodium restriction, reduction of alcohol intake, and weight loss if obese, are critical in treating resistant hypertension. Pharmacological treatment should be tailored to the patient's profile and focus on the causative pathway of resistance. Exclusion of preparations that contribute to true BP treatment resistance, such as nonsteroidal anti-inflammatory agents, cold preparations, and certain herbs, is also important. Lastly, BP control can only be achieved if an antihypertensive treatment regimen is used that focuses on the genesis of the hypertension. An example is volume overload, a common but unappreciated cause of treatment resistance. Use of the appropriate dose and type of diuretic provides a solution to overcome treatment resistance in this instance. Patients with uncontrolled hypertension despite receiving an optimal therapy are candidates for newer interventional therapies such as carotid baroreceptor stimulation and renal denervation.

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Plasma Aldosterone Is Related to Severity of Obstructive Sleep Apnea in Subjects With Resistant Hypertension

Cited by 290 publications

References 33 publications

Sleep Apnea and Cardiovascular Disease

Sleep Apnea and Cardiovascular Disease

Obstructive sleep apnea syndrome and hypertension: mechanism of the linkage and 24-h blood pressure control

Resistant hypertension: Definition, evaluation, and new therapeutic approaches to treatment

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