Pratt-Ubunama Monique N, Nishizaka Mari K, Boedefeld Robyn L, Cofield Stacey S, Harding Susan M, Calhoun David A
Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
Chest. 2007 Feb;131(2):453-9. doi: 10.1378/chest.06-1442.
Obstructive sleep apnea (OSA) and primary aldosteronism are common in subjects with resistant hypertension; it is unknown, however, if the two disorders are causally related. This study relates plasma aldosterone and renin levels to OSA severity in subjects with resistant hypertension, and in those with equally severe OSA but without resistant hypertension serving as control subjects.
Seventy-one consecutive subjects referred to the University of Alabama at Birmingham (UAB) for resistant hypertension (BP uncontrolled on three medications) and 29 control subjects referred to UAB Sleep Disorders Center for suspected OSA were prospectively evaluated by an early morning plasma aldosterone concentration (PAC) and renin level, and by overnight, attended polysomnography.
OSA (apnea-hypopnea index [AHI] > or = 5/h) was present in 85% of subjects with resistant hypertension. In these subjects, PAC correlated with AHI (rho = 0.44, p = 0.0002) but not renin concentration. Median PAC was significantly lower in control subjects compared to subjects with resistant hypertension (5.5 ng/dL vs 11.0 ng/dL, p < 0.05) and not related to AHI. In male subjects compared to female subjects with resistant hypertension, OSA was more common (90% vs 77%) and more severe (median AHI, 20.8/h vs 10.8/h; p = 0.01), and median PAC was significantly higher (12.0 ng/dL vs 8.8 ng/dL, p = 0.006).
OSA is extremely common in subjects with resistant hypertension. A significant correlation between PAC and OSA severity is observed in subjects with resistant hypertension but not in control subjects. While cause and effect cannot be inferred, the data suggest that aldosterone excess may contribute to OSA severity.
阻塞性睡眠呼吸暂停（OSA）和原发性醛固酮增多症在顽固性高血压患者中很常见；然而，这两种疾病是否存在因果关系尚不清楚。本研究将血浆醛固酮和肾素水平与顽固性高血压患者以及同样患有严重OSA但无顽固性高血压的对照受试者的OSA严重程度相关联。
连续71名因顽固性高血压（使用三种药物血压仍未得到控制）转诊至阿拉巴马大学伯明翰分校（UAB）的受试者以及29名因疑似OSA转诊至UAB睡眠障碍中心的对照受试者，通过清晨血浆醛固酮浓度（PAC）和肾素水平以及整夜的多导睡眠监测进行前瞻性评估。
85%的顽固性高血压患者存在OSA（呼吸暂停低通气指数[AHI]≥5次/小时）。在这些患者中，PAC与AHI相关（ρ=0.44，p=0.0002），但与肾素浓度无关。对照受试者的PAC中位数显著低于顽固性高血压患者（5.5 ng/dL对11.0 ng/dL，p<0.05），且与AHI无关。与患有顽固性高血压的女性受试者相比，男性受试者中OSA更常见（90%对77%）且更严重（AHI中位数，20.8次/小时对10.8次/小时；p=0.01），且PAC中位数显著更高（12.0 ng/dL对8.8 ng/dL，p=0.006）。
OSA在顽固性高血压患者中极为常见。在顽固性高血压患者中观察到PAC与OSA严重程度之间存在显著相关性，但在对照受试者中未观察到。虽然不能推断因果关系，但数据表明醛固酮过多可能导致OSA严重程度增加。
