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Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report
Open accessAbstract
Obstructive sleep apnoea (OSA) and hyperaldosteronism are very common in subjects with resistant hypertension. We hypothesized that aldosterone-mediated chronic fluid retention may influence OSA severity in patients with resistant hypertension. We tested this in an open-label evaluation by assessing the changes in the severity of OSA in patients with resistant hypertension after treatment with spironolactone. Subjects with resistant hypertension (clinical blood pressure (BP) >or=140/90 mm Hg on >or=3 antihypertensive medications, including a thiazide diuretic and OSA (defined as an apnoea-hypopnoea index (AHI) >or=15) had full diagnostic, polysomnography before and 8 weeks after spironolactone (25-50 mg a day) was added to their ongoing antihypertensive therapy. In all, 12 patients (mean age 56 years and body mass index 36.8 kg m(-2)) were evaluated. After treatment with spironolactone, the AHI (39.8+/-19.5 vs 22.0+/-6.8 events/h; P<0.05) and hypoxic index (13.6+/-10.8 vs 6.7+/-6.6 events/h; P<0.05), weight and clinic and ambulatory BP were significantly reduced. Plasma renin activity (PRA) and serum creatinine were significantly higher. This study provides preliminary evidence that treatment with a mineralocorticoid receptor antagonist substantially reduces the severity of OSA. If confirmed in a randomized assessment, it will support aldosterone-mediated chronic fluid retention as an important mediator of OSA severity in patients with resistant hypertension.
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“The role of aldosterone in promoting OSA is additionally supported by studies demonstrating that mineralocorticoid receptor antagonists reduce the severity of OSA in patients with RH.280–282”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [280]
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Cites
Rechtschaffen, A. (1968) · Medical Entomology and Zoology · Cited by 11,772
Marin, J. M., Carrizo, S. J., Vicente, E., & Agusti, A. G. (2005) · The Lancet · doi:10.1016/s0140-6736(05)71141-7 · Cited by 4,678
The Triad of Sleep Apnea, Hypertension, and Chronic Kidney Disease: A Spectrum of Common Pathology
Aziz, F., & Chaudhary, K. R. (2016) · Cardiorenal Medicine · doi:10.1159/000450796 · Cited by 3,285
Obstructive Sleep Apnea as a Risk Factor for Stroke and Death
Yaggi, H. K., Concato, J., Kernan, W. N., Lichtman, J. H., Brass, L. M., & Mohsenin, V. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa043104 · Cited by 3,004
Using the Berlin Questionnaire To Identify Patients at Risk for the Sleep Apnea Syndrome
Netzer, N. C., Stoohs, R. A., Netzer, C. M., Clark, K., & Strohl, K. P. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-131-7-199910050-00002 · Cited by 2,973
Sleep-disordered Breathing and Cardiovascular Disease
SHAHAR, E., WHITNEY, C. W., REDLINE, S., LEE, E. T., NEWMAN, A. B., JAVIER NIETO, F., O'CONNOR, G. T., BOLAND, L. L., SCHWARTZ, J. E., & SAMET, J. M. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.1.2001008 · Cited by 2,901
A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients
Rossi, G. P., Bernini, G., Caliumi, C., Desideri, G., Fabris, B., Ferri, C., Ganzaroli, C., Giacchetti, G., Letizia, C., Maccario, M., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.07.059 · Cited by 1,467
High prevalence of unrecognized sleep apnoea in drug-resistant hypertension
Logan, A. G., Perlikowski, S. M., Mente, A., Tisler, A., Tkacova, R., Niroumand, M., Leung, R. S. T., & Bradley, T. D. (2001) · Journal of Hypertension · doi:10.1097/00004872-200112000-00022 · Cited by 960
Hyperaldosteronism Among Black and White Subjects With Resistant Hypertension
Calhoun, D. A., Nishizaka, M. K., Zaman, M. A., Thakkar, R. B., & Weissmann, P. (2002) · Hypertension · doi:10.1161/01.hyp.0000040261.30455.b6 · Cited by 763
Self-citationEnhanced Release of Superoxide from Polymorphonuclear Neutrophils in Obstructive Sleep Apnea
Schulz, R., MAHMOUDI, S., Hattar, K., Sibelius, U., Olschewski, H., Mayer, K., Seeger, W., & Grimminger, F. (2000) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.162.2.9908091 · Cited by 639
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The Triad of Sleep Apnea, Hypertension, and Chronic Kidney Disease: A Spectrum of Common Pathology
Aziz, F., & Chaudhary, K. R. (2016) · Cardiorenal Medicine · doi:10.1159/000450796 · Cited by 3,285
The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019)
Umemura, S., Arima, H., Arima, S., Asayama, K., Dohi, Y., Hirooka, Y., Horio, T., Hoshide, S., Ikeda, S., Ishimitsu, T., et al. (2019) · Hypertension Research · doi:10.1038/s41440-019-0284-9 · Cited by 1,880
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Somers, V. K., White, D. P., Amin, R. S., Abraham, W. T., Costa, F., Culebras, A., Daniels, S. R., Floras, J. S., Hunt, C. E., Olson, L. J., et al. (2008) · Circulation · doi:10.1161/circulationaha.107.189420 · Cited by 1,347
Carey, R. M., Calhoun, D. A., Bakris, G. L., Brook, R. D., Daugherty, S. L., Dennison-Himmelfarb, C. R., Egan, B. M., Flack, J. M., Gidding, S. S., Judd, E., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000084 · Cited by 1,153
Self-citationDiretrizes Brasileiras de Hipertensão Arterial – 2020
Barroso, W. K. S., Rodrigues, C. I. S., Bortolotto, L. A., Gomes, M. A. M., Brandão, A. A., Feitosa, A. D. M., Machado, C. A., Poli‐de‐Figueiredo, C. E., Amodeo, C., Mion, D., et al. (2021) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20201238 · Cited by 1,389
Metadata
- Authors
- Gaddam, K., Pimenta, E., Thomas, S. J., Cofield, S. S., Oparil, S., Harding, S. M., & Calhoun, D. A.
- Affiliations
- Ochsner Medical Center (US)
- The University of Queensland (AU)
- University of Alabama at Birmingham (US)
- Corresponding author
- Calhoun, D A
- Venue
- Journal of Human Hypertension
- Published
- 2009-12-17
- Volume
- 24
- Issue
- 8
- Pages
- 532-537
- ISSN
- 0950-9240 (ISSN-L)
- 1476-5527
- PMC
- PMC2891919
- OpenAlex
- W2076462334
- Cited by
- 289
- References
- 26
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 10 · 2023: 13 · 2022: 14 · 2021: 12 · 2020: 17 · 2019: 21 · 2018: 19 · 2017: 16 · 2016: 23 · 2015: 25 · 2014: 33 · 2013: 17 · 2012: 22
- FWCI
- 10.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Human Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01-HL79040, R01HL079040, R01HL075614, P50HL077100, T32HL007457)
- National Center for Research Resources (M01RR00032, M01RR000032)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Pharmacology (medical) › Apelin-related biomedical research
- Keywords
- spironolactone, obstructive sleep apnea, resistant hypertension, hyperaldosteronism, mineralocorticoid receptor antagonists, aldosterone, fluid retention, apnea-hypopnea index, plasma renin activity, blood pressure
- MeSH terms
- Blood Pressure, Diuretics, Drug Resistance, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Pilot Projects, Severity of Illness Index, Spironolactone, Treatment Outcome, Polysomnography, Sleep Apnea, Obstructive
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