Increased Dietary Sodium Is Related to Severity of Obstructive Sleep Apnea in Patients With Resistant Hypertension and Hyperaldosteronism
ABSTRACT ABSTRACT BACKGROUND: Obstructive sleep apnea (OSA) is a strong and independent risk factor for the development of hypertension, particularly resistant hypertension, and cardiovascular diseases. Patients with resistant hypertension have a high prevalence of OSA in association with elevated aldosterone levels, high salt intake, and salt-sensitivity of blood pressure. OBJECTIVES: Determine if dietary salt and aldosterone are associated with severity of OSA in patients with resistant hypertension. METHODS: Ninety-seven patients with resistant hypertension were prospectively evaluated by overnight polysomnography and 24-hour urinary sodium excretion (UNa) and aldosterone while ingesting their usual diet. Hyperaldosteronism was defined as PRA < 1 ng/mL/hr and UAldo ≥ 12 µg/24-hr. RESULTS: Overall, the mean clinic blood pressure (BP) was 156.3±22.4/88.9±13.3 mm Hg on an average 4.3±1.1 antihypertensive medications. Prevalence of OSA was 77.3%. Twenty-eight (28.9%) of patients were diagnosed with hyperaldosteronism. UNa was an independent predictor of severity of OSA only in patients with hyperaldosteronism. CONCLUSIONS: The current findings suggest that dietary salt is related to the severity of OSA in patients with resistant hypertension and hyperaldosteronism. Our results support dietary salt restriction as a treatment strategy for reduction of OSA severity in these patients.
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ABSTRACT: Rationale: We hypothesized that untreated severe obstructive sleep apnea (OSA) is associated with elevated ambulatory blood pressure (BP) in subjects with high cardiovascular disease (CVD) risk despite medical management. Methods: Data from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a 4-site randomized controlled trial were analyzed. Individuals with moderate-severe OSA (apnea hypopnea index, AHI = 15-50) and cardiovascular risk were recruited from cardiology practices. Those with hypertension were included. Intensive antihypertensive regimen (IAR) was defined as >= 3 antihypertensives including a diuretic. Definitions were: controlled BP (BP < 130/80), uncontrolled elevated BP (BP >= 130/80 not on IAR) and resistant elevated BP (BP >= 130/80 mm Hg despite IAR). Associations of untreated severe OSA (AHI >= 30) and uncontrolled and resistant elevated BP were evaluated using logistic regression analyses adjusted for age, sex, race, body mass index, smoking status, diabetes, and CVD. Results: Among the 284 participants (mean age 63.1 +/- 7.2 years, 23.6% with severe OSA), 61.6% had controlled BP, 28.5% had uncontrolled elevated BP, and 9.9% had resistant elevated BP. Among participants prescribed IAR, resistant elevated BP was more prevalent in those with severe compared to moderate OSA (58.3% vs. 28.6%, p = 0.01). Participants with severe OSA had a 4-fold higher adjusted odds of resistant elevated BP (OR 4.1, 95% CI: 1.7-10.2), a fi nding not reproduced in the absence of IAR use. Conclusions: Among patients with increased cardiovascular risk and moderate to severe OSA, untreated severe compared to moderate OSA was associated with elevated BP despite IAR suggesting untreated severe OSA contributes to poor BP control despite aggressive medication use. Commentary: A commentary on this article appears in this issue on page 845.Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2014; 10(8):835-43. DOI:10.5664/jcsm.3946 · 2.83 Impact Factor
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ABSTRACT: Among patients with resistant hypertension, primary aldosteronism (PA) is worth detecting as it appears to be particularly common in this cohort. It is associated with excessive cardiovascular morbidity in relation to the degree of hypertension and reduced quality of life, both of which can be abrogated with specific surgical or medical treatment. Knowledge concerning factors (including medications) which can influence the results of screening by aldosterone/renin ratio (ARR) testing is expanding, and is important to appreciate, particularly in patients with resistant hypertension, in whom the need for multiple medications can render interpretation challenging. Advances in approaches to confirmatory testing, subtype differentiation and assay methodology are helping to improve feasibility and reliability of the diagnostic workup for PA and new treatment approaches are emerging. Major developments in understanding the genetic bases for PA hold promise towards further improvements and options in diagnosis and therapy.Current Hypertension Reports 07/2014; 16(7):439. DOI:10.1007/s11906-014-0439-7 · 3.90 Impact Factor
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2014; 10(8):845-6. DOI:10.5664/jcsm.3948 · 2.83 Impact Factor