Abstract
Objectives: Coexistence of primary aldosteronism and obstructive sleep apnea in hypertension is evidenced. However, aldosterone and renin activity is varying with apnea/hypopnea index changes in subjects with resistant hypertension. Thus, the aim is to investigate the optional cutoff value for aldosterone/renin activity to screen primary aldosteronism in patients with different status of apnea/hypopnea index. Methods: 271 hypertensive male snores were evaluated via polysomnography and divided into two groups, group with apnea/hypopnea index >15 events/h and with apnea/hypopnea index 15 ng/dL performed saline infusion test, after which aldosterone concentration>5 ng/dL was a sign of primary aldosteronism. Receiver operating characteristic curve was applied to explore appropriate cutoff value for aldosterone/renin activity. Results: 39 (14.4%) of the 271 were diagnosed with primary aldosteronism including 15 with apnea/hypopnea index 15 events/h. Area under receiver operating characteristic curve was 0.97 (95%CI 0.94-0.99) in the group with apnea/hypopnea index >15 events/h and 0.91 (95%CI 0.87-0.96) in the group with apnea/hypopnea index 15 events/h with sensitivity 100%, specificity 69.7%. Youden index is 0.9 for the group with apnea/hypopnea index 15 events/h. Conclusions: Optional cutoff values of aldosterone/renin activity to screening for primary aldosteronism should be considered in patients with different status of apnea/hypopnea index.
Highlights
Overall the prevalence of hypertension appears to be around 3040% of the general population
Demographic parameters were noted in all patients groups: body mass index (BMI), waist circumference (WC) and clinic blood pressure
Primary aldosteronism (PA) was diagnosed in 39 (14.4%) patients: 15 (38.4%) of patients with apnea/hypopnea index (AHI)15 events/h 39 (14.4%) on the basis of diagnostic schema for PA (Table 3). Of those with AHI more than or equal to 5 events/h, 32 patients were made a diagnosis of PA, accounting for 11.8%
Summary
Overall the prevalence of hypertension appears to be around 3040% of the general population. The relationship between blood pressure (BP) values and cardiovascular and events has been addressed in a body of observational studies [1,2]. Etiology of hypertension is manifold and complicated, involving life styles of individuals, environmental factors, secondary diseases and gene polymorphisms [3,4,5,6,7]. Identified obstructive sleep apnea (OSA) via polysomnography appears to be the most common condition association with resistant hypertension [8]. OSA affects hypertensive patients through other cardiovascular diseases, including coronary artery disease, arrhythmia and stroke [9,10,11]
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