Relationship between primary aldosteronism and obstructive sleep apnoea, metabolic abnormalities and cardiac structure in patients with resistant hypertension
Open accessAbstract
INTRODUCTION: The aim of this study was to evaluate in patients with resistant hypertension (RHTN) enrolled in the RESIST-POL study the relationship between primary aldosteronism (PA) and obstructive sleep apnoea (OSA) and their effect on metabolic abnormalities and cardiac structure. MATERIAL AND METHODS: We included 204 patients (123 M, 81 F, mean age 48.4 yrs) with true RHTN, eGFR > 60 mL/min/1,73 m(2) and no known diabetes. OSA was defined as an apnoea/hypopnoea index of 15/h or more. Metabolic syndrome components were assessed. On echocardiography, left ventricular hypertrophy (LVH), concentric remodelling (RWT > 0.45), E' velocity, E/E' index and global strain (GLS) were evaluated. RESULTS: PA was diagnosed in 32 patients (15.7%). OSA occurred more frequently in patients with PA (59.4 v. 42.4%; p = 0.058). Patients were divided into four groups: PA+ OSA+ , PA+ OSA-, PA-OSA+ and PA-OSA-. Newly diagnosed diabetes, impaired glucose tolerance and increased fasting glucose were most frequent in the PA+ OSA+ group compared to other groups. The presence of OSA was associated with concentric remodelling, and the presence of PA was associated with higher left ventricular mass and higher frequency of left ventricular hypertrophy. In the PA+ OSA+ and PA+ OSA- groups, the most frequent geometry patterns were concentric hypertrophy (68.4%) and eccentric hypertrophy (54.5%) respectively. E' velocity was lowest and E/E' was highest in PA+ OSA+ compared to other groups. GLS was lower in patients with OSA compared to those without OSA. CONCLUSIONS: Both metabolic abnormalities and target organ damage are more pronounced in patients with RHTN, PA and OSA. OSA and PA influence differently left ventricular geometry.
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The high occurrence of obstructive sleep apnea in patients with resistant hypertension has been attributed to increased fluid retention and accompanying upper airway edema, as suggested by studies positively relating the presence and severity of obstructive sleep apnea to aldosterone excess and high dietary sodium intake.
“The high occurrence of OSA in patients with RH has been attributed to increased fluid retention and accompanying upper airway edema, as suggested by studies positively relating the presence and severity of OSA to aldosterone excess and high dietary sodium intake.47,49,277–279”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [279]
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- Authors
- Prejbisz, A., Florczak, E., Klisiewicz, A., Dobrowolski, P., Janaszek-Sitkowska, H., Bieleń, P., Szwench-Pietrasz, E., Warchoł-Celińska, E., Kołodziejczyk-Kruk, S., Janas, J., Kabat, M., Imiela, J., Śliwiński, P., & Januszewicz, A.
- Affiliations
- Institute of Cardiology (PL)
- Międzyleski Szpital Specjalistyczny w Warszawie (PL)
- Corresponding author
- Prejbisz, Aleksander
- ORCID
- Venue
- Endokrynologia Polska
- Publisher
- VM Media SP. zo.o VM Group SK
- Published
- 2013-11-04
- Volume
- 64
- Issue
- 5
- Pages
- 363-367
- ISSN
- 0423-104X (ISSN-L)
- OpenAlex
- W2329417086
- Cited by
- 33
- References
- 23
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 1 · 2022: 7 · 2021: 4 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 2 · 2015: 2
- FWCI
- 0.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Endokrynologia Polska (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- primary aldosteronism, obstructive sleep apnea, resistant hypertension, metabolic syndrome, left ventricular hypertrophy, left ventricular remodeling, left ventricular mass, global longitudinal strain, diastolic function, target organ damage, diabetes mellitus, impaired glucose tolerance
- MeSH terms
- Echocardiography, Female, Humans, Hyperaldosteronism, Hypertension, Male, Middle Aged, Comorbidity, Hypertrophy, Left Ventricular, Ventricular Dysfunction, Left, Sleep Apnea, Obstructive, Metabolic Syndrome
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