Abstract 15037: Hyperreninemic Aldosteronism in Caucasian and African-American Patients With Apparent Resistant Hypertension

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Rajat Kalra ◽  
Lama Ghazi ◽  
David A Calhoun ◽  
Suzanne Oparil ◽  
Tanja Dudenbostel
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
African American ◽  
Sleep Apnea ◽  
Plasma Renin Activity ◽  
Systolic Blood Pressure ◽  
Resistant Hypertension ◽  
Plasma Renin ◽  
Renin Activity ◽  
Obstructive Sleep

Introduction: While primary aldosteronism (PA) is a recognized and relatively well-defined cause of resistant hypertension (RHTN), there is a relative paucity of data defining patients with hyperreninemic aldosteronism (HA) and RHTN. Hypothesis: We sought to identify characteristics of patients with HA and compare them to patients with and without PA within a large cohort of patients with RHTN. Methods: We analyzed 1236 RHTN patients who were referred to our Hypertension Clinic with and underwent complete biochemical work-up including plasma aldosterone concentration, plasma renin activity, and 24-hour urinary aldosterone. Demographics, antihypertensive drug regimen, comorbidities, biochemical parameters and evaluation for secondary RHTN, where indicated, were evaluated. Hyperreninemic aldosteronism was defined as plasma renin activity >1 ng/mL*hr, aldosterone-renin-ratio of ≈ 8 or more, and 24-hour urinary aldosterone >12 mcg/24h. Results: In 128 eligible patients with resistant hypertension and HA, the mean age was 52.9±12.1 years with 56% being males (Table). Systolic and diastolic blood pressures were 149.2±22.0 and 87.9±15.5 mm Hg, respectively. Significant numbers of HA patients had co-morbid obesity (63.3%) and obstructive sleep apnea (44.9%). Compared to patients with PA, patients with HA had statistically significant lower proportions of patients with African-American race and systolic blood pressure. Compared to all RHTN patients, HA patients had lower mean age and systolic blood pressure, but were more likely to be male and have obstructive sleep apnea. Conclusions: Resistant hypertension due to hyperreninemic aldosteronism appears to predominantly affect obese, middle-aged males. Patients with HA causing RHTN have distinct differences from PA patients with RHTN. More investigation is required to identify appropriate treatment protocols for this poorly defined subset of patients with RHTN.

scholarly journals Predictors of chronic kidney disease in obstructive sleep apnea patients

2020 ◽  
Vol 15 ◽  
Author(s):  
Phunphai Somkearti ◽  
Paiboon Chattakul ◽  
Sittichai Khamsai ◽  
Panita Limpawattana ◽  
Jarin Chindaprasirt ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Chronic Kidney Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
High Systolic Blood Pressure ◽  
Mallampati Score ◽  
Obstructive Sleep

Introduction: Obstructive sleep apnea (OSA) is a common condition in patients with chronic kidney disease (CKD). It may worsen renal function in CKD patients and is associated with uncontrolled blood pressure. Although OSA is found in up to 80% of CKD patients, there are limited data available on its clinical features in patients with and without CKD. Objective: This study aimed to identify the differences in the clinical characteristics of OSA between CKD and non-CKD OSA patients and determine the clinical predictors for CKD in OSA patients. Methods: This was a retrospective study conducted at Khon Kaen University's Srinagarind Hospital in Thailand between July and December 2018. The inclusion criteria were diagnosis with OSA via polysomnography and having undergone laboratory tests for CKD. Obstructive sleep apnea is diagnosed according to the apnea-hypopnea index (AHI) as experiencing >5 events/hour, while CKD diagnosed based on the KDOQI guidelines. Eligible patients were divided into two groups: OSA with CKD and OSA without CKD. Predictors of CKD in OSA patients were analyzed using multivariate logistic regression analysis. Results: During the study period, there were 178 OSA patients who met the study criteria, 88 (49.44%) of whom were in the OSA with CKD group. Both age and body mass index were comparable between OSA patients with CKD and those without (age: 59 and 57 years, respectively; body mass index: 30 and 29 kg/m2, respectively. There were three significant factors that differed between those with and without CKD group including systolic blood pressure (147 vs 135 mmHg), proportion of patients with diabetes (55% vs 34%), and proportion of patients with Mallampati scores of 3-4 (73% vs 39%). There were three independent predictors for OSA in patients with CKD: female sex, high systolic blood pressure, and Mallampati score of 3 or 4, with adjusted odds ratios (95% confidence interval) of 4.624 (1.554, 13.757), 1.060 (1.020, 1.101), and 2.816 (1.356, 5.849), respectively. The Hosmer-Lemeshow chi square statistic of the predictive model was 6.06 (p 0.640). Systolic blood pressure of more than 130 and 150 mmHg resulted in sensitivity of 84.21% and specificity of 81.40%, respectively. Conclusions: Female sex, high systolic blood pressure, and Mallampati score of 3-4 were suggestive of OSA with CKD. Obstructive sleep apnea patients with one or more of these predictors may have a high risk of CKD.

Influence of Family History of Hypertension on the Relationships between Blood Pressure, Body Weight, Electrolyte Metabolism, Renin, Prolactin and Parathormone

1981 ◽  
Vol 61 (s7) ◽  
pp. 359s-362s ◽  
Author(s):  
F. Wessels ◽  
D. Hoffmann ◽  
H. Wagner ◽  
H. Zumkley
Keyword(s):  
Blood Pressure ◽  
Body Weight ◽  
Family History ◽  
Plasma Renin Activity ◽  
Systolic Blood Pressure ◽  
Plasma Renin ◽  
Renin Activity ◽  
Creatinine Ratio ◽  
History Of ◽  
Family History Of Hypertension

1. The influence of family history of hypertension on the relationships between blood pressure, relative body weight, sodium/creatinine ratio of the 24 h urine, plasma renin activity and the plasma concentration of prolactin and parathormone were examined in 102 healthy male students. 2. Grouping together results from all students showed significant positive correlations between systolic blood pressure and prolactin, parathormone as well as relative body weight, between plasma renin activity and prolactin and a significant negative correlation between plasma renin activity and sodium/creatinine ratio of the 24 h urine. 3. By dividing the students into two groups according to their family history of hypertension we could demonstrate in those with family history of hypertension a highly significant positive correlation between mean blood pressure and sodium/creatinine ratio of the 24 h urine and an improvement of the correlations between systolic blood pressure and prolactin and between sodium/creatinine ratio of the 24 h urine and plasma renin activity. In students without family history of hypertension these relationships were no longer detectable. In the students without family history of hypertension the correlations between systolic blood pressure and relative body weight as well as between plasma renin activity and prolactin gained substantially in significance. In students with positive family history of hypertension these correlations could no longer be demonstrated. The correlations between systolic blood pressure and parathormone remained unaffected by family history of hypertension. 4. The results suggest that a genetic predisposition to essential hypertension is able to intensify the blood pressure effect of Na intake and of prolactin, which, besides its function as a sex hormone, is presumed additionally to be able to retain salt. However, the positive relationship between body weight and blood pressure, as well as between plasma renin activity and prolactin, the significance of which increases greatly in subjects without family history of hypertension, appears to be lost as the result of the increased sensitivity to salt in positive family history of hypertension.

Effect of Adenotonsillectomy on Ambulatory Blood Pressure in Pediatric Obstructive Sleep Apnea: 6-Month Follow-up Study

2019 ◽  
Vol 160 (5) ◽  
pp. 911-921 ◽  
Author(s):  
Kun-Tai Kang ◽  
Shuenn-Nan Chiu ◽  
Che-Yi Lin ◽  
Wen-Chin Weng ◽  
Pei-Lin Lee ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Apnea Hypopnea Index ◽  
Study Cohort ◽  
Obstructive Sleep ◽  
Pressure Changes

Objective To investigate 24-hour ambulatory blood pressure changes 6 months after surgery among children with obstructive sleep apnea. Study Design Prospective interventional study. Setting Tertiary medical hospital. Subjects and Methods Children aged 4 to 16 years with symptoms of obstructive sleep apnea (apnea-hypopnea index >1) were recruited. All children underwent adenotonsillectomy and postoperative polysomnography overnight. The 24-hour ambulatory blood pressure was measured before and 6 months after surgery. Results The study cohort enrolled 124 children: mean (SD) age, 7.3 (3.1) years; 73% boys. After surgery, the apnea-hypopnea index significantly decreased from 13.3 (18.1) to 3.3 (7.2) events per hour ( P < .001). Overall systolic blood pressure and diastolic blood pressure were not significantly different following surgery, while daytime systolic blood pressure was slightly increased (114.3 to 117.3 mm Hg, P < .01) postoperatively. The hypertensive group (n = 43) exhibited significantly decreased levels of overall diastolic, nighttime systolic, and nighttime diastolic blood pressure ( P < .05), and 54% of hypertensive children became nonhypertensive after surgery. The nonhypertensive group (n = 81) showed slightly increased levels of nocturnal overall systolic, daytime systolic, and nighttime systolic blood pressure. A generalized linear mixed model revealed that children with hypertension had a greater decrease in systolic and diastolic ambulatory blood pressure during the daytime and nighttime (all P < .05) than those without hypertension. Conclusions Ambulatory blood pressure changes after adenotonsillectomy among children with obstructive sleep apnea are minimal. The decrease in ambulatory blood pressure after surgery is more prominent for hypertensive children than nonhypertensive children.

Effects of salmon calcitonin on plasma renin activity and systolic blood pressure in the rat

1986 ◽  
Vol 66 (3) ◽  
pp. 351-355 ◽  
Author(s):  
G. Clementi ◽  
E. Rapisarda ◽  
C.E. Fiore ◽  
A. Prato ◽  
M. Amico-Roxas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Plasma Renin Activity ◽  
Systolic Blood Pressure ◽  
Salmon Calcitonin ◽  
Plasma Renin ◽  
Renin Activity
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