Resistant hypertension, obstructive sleep apnoea and aldosterone

Background: Resistant hypertension, a special phenotype of hypertension, is associated with increased cardiovascular risk. Exercise and physical activity are recommended as non-pharmacological interventions to manage blood pressure in hypertension. Little is known about the effectiveness of exercise in resistant hypertension. A bidirectional relationship has been identified between resistant hypertension and obstructive sleep apnoea but the literature pertaining to the benefit of exercise for populations with both conditions, is minimal. This study aims to identify the effectiveness of exercise in reducing blood pressure in a cohort of adults with resistant hypertension and high risk of obstructive sleep apnoea.Methods: Dunedin based adults with resistant hypertension and high risk of obstructive sleep apnoea will be recruited from the community and health centres to participate in the study. Consenting volunteers (no. of fourteen) will participate in a 12-week exercise programme including aerobic and strength training. The primary outcome measure will be 24h ambulatory blood pressure while the secondary outcomes will be anthropometrics, activity parameters, sleep parameters, cardiac structure and function, and quality of life. The measurements at the end of the 12-week exercise programme will be compared with baseline to determine the effectiveness of exercise in reducing blood pressure in the cohort with resistant hypertension and risk of obstructive sleep apnoea.Conclusions: Exercise and physical activity are recommended to manage hypertension. Therefore, it is anticipated that the exercise programme will have a positive effect on the blood pressure of the participants. The findings have potential to change the direction of research in the area by filling the knowledge gaps.Trial Registration: The Ministry of Health, New Zealand (Ethics Ref: 18/CEN/257), Trial registry: ACTRN12618001881224p).

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Time to recognize continuous positive airway pressure as a blood pressure-lowering treatment in patients with obstructive sleep apnoea and resistant hypertension?

Journal of Hypertension ◽

10.1097/hjh.0000000000002676 ◽

2021 ◽

Vol 39 (2) ◽

pp. 234-235

Author(s):

Martino F. Pengo ◽

Carolina Lombardi ◽

Grzegorz Bilo ◽

Gianfranco Parati

Keyword(s):

Blood Pressure ◽

Continuous Positive Airway Pressure ◽

Obstructive Sleep Apnoea ◽

Resistant Hypertension ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Apnoea ◽

Blood Pressure Lowering ◽

Obstructive Sleep ◽

Pressure Lowering

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Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report

Journal of Human Hypertension ◽

10.1038/jhh.2009.96 ◽

2009 ◽

Vol 24 (8) ◽

pp. 532-537 ◽

Cited By ~ 171

Author(s):

K Gaddam ◽

E Pimenta ◽

S J Thomas ◽

S S Cofield ◽

S Oparil ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Resistant Hypertension ◽

Preliminary Report ◽

Sleep Apnoea ◽

Obstructive Sleep

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Eplerenone as a treatment for resistant hypertension in pregnancy

Obstetric Medicine ◽

10.1177/1753495x19825967 ◽

2019 ◽

pp. 1753495X1982596

Author(s):

Jessica Gehlert ◽

Adam Morton

Keyword(s):

Obstructive Sleep Apnoea ◽

Resistant Hypertension ◽

Mineralocorticoid Receptor ◽

Sleep Apnoea ◽

Primary Hyperaldosteronism ◽

Mineralocorticoid Receptor Antagonists ◽

Receptor Antagonists ◽

Mineralocorticoid Receptor Antagonist ◽

Obstructive Sleep ◽

In Pregnancy

Mineralocorticoid receptor antagonists are highly effective in the management of resistant hypertension and primary hyperaldosteronism. Recent studies demonstrate that mineralocorticoid receptor antagonists significantly reduce blood pressure, severity of obstructive sleep apnoea and arterial stiffness in patients with resistant hypertension and moderate–severe obstructive sleep apnoea. Eplerenone is a selective mineralocorticoid receptor antagonist that does not act as an androgen receptor blocker, thus reducing the risk of fetal anti-androgenic effects. Rat and rabbit studies demonstrated that when exposed to 30 times the equivalent therapeutic human dose, 100 mg/day, there were no teratogenic or demasculinisation effects. To date, the use of eplerenone has been reported in six human pregnancies in women with Gitelman syndrome, primary hyperaldosteronism and cardiac failure, in which no teratogenic effects were seen. Described here is a case of resistant hypertension associated with obstructive sleep apnoea in pregnancy, treated with eplerenone. The potential role of using eplerenone in pregnancy as treatment for resistant hypertension is discussed. Trial registration: Not applicable.

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ARTERIAL STIFFNESS AND OBSTRUCTIVE SLEEP APNOEA SEVERITY ASSOCIATION IN PATIENTS WITH RESISTANT HYPERTENSION

Journal of Hypertension ◽

10.1097/01.hjh.0000571412.91342.44 ◽

2019 ◽

Vol 37 ◽

pp. e109

Author(s):

C. Roderjan ◽

A. Cavalcanti ◽

A. Cortez ◽

B. Chedier ◽

E. Muxfeldt ◽

...

Keyword(s):

Arterial Stiffness ◽

Obstructive Sleep Apnoea ◽

Resistant Hypertension ◽

Sleep Apnoea ◽

Obstructive Sleep

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Performance of NoSAS score versus Berlin questionnaire for screening obstructive sleep apnoea in patients with resistant hypertension

Journal of Human Hypertension ◽

10.1038/s41371-018-0072-z ◽

2018 ◽

Vol 32 (7) ◽

pp. 518-523 ◽

Cited By ~ 9

Author(s):

Sara Q. C. Giampá ◽

Rodrigo P. Pedrosa ◽

Carolina C. Gonzaga ◽

Adriana Bertolami ◽

Celso Amodeo ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Resistant Hypertension ◽

Sleep Apnoea ◽

Berlin Questionnaire ◽

Obstructive Sleep

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Common Secondary Causes of Resistant Hypertension and Rational for Treatment

International Journal of Hypertension ◽

10.4061/2011/236239 ◽

2011 ◽

Vol 2011 ◽

pp. 1-17 ◽

Cited By ~ 39

Author(s):

Charles Faselis ◽

Michael Doumas ◽

Vasilios Papademetriou

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Obstructive Sleep Apnoea ◽

Resistant Hypertension ◽

Primary Aldosteronism ◽

Salt Intake ◽

Antihypertensive Drugs ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Secondary Causes

Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Drug-induced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. Obstructive sleep apnoea and primary aldosteronism are frequently encountered in patients with resistant hypertension and require expert management. Hypertension is commonly found in patients with chronic kidney disease and is frequently resistant to treatment, while the management of renovascular hypertension remains controversial. A step-by-step approach of patients with resistant hypertension is proposed at the end of this review paper.

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