PP.34.04] EFFECT OF EPLERENONE ON APNOEA-HYPOPNOEA INDEX IN PATIENTS WITH RESISTANT HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA

Abstract

Objective: To determine if the addition of eplerenone to the hypotensive treatment reduces the severity of obstructive sleep apnea (OSA) in patients with resistant hypertension and OSA Design and method: 38 consecutive patients with OSA (25 men and 13 women) aged 57.76+/-6.16 were referred to Department of Hypertension with diagnosis of resistant hypertension. Resistant hypertension was defined as uncontrolled hypertension despite the use of at least three hypotensive drugs including diuretics. Exclusion criteria were: secondary hypertension, myocardial infarction, stroke within six months before the study, chronic heart failure NYHA III and IV, chronic kidney failure (GFR<30 ml/min), alcohol or drugs abuse, active cancer. All subjects underwent following examinations: BP measurement with OMRON 705IT sphygmomanometer – mean value from 3 measurements after 15 min. of rest was used; 24-hour ambulatory BP monitoring using 2430TM A&D device; assessment of aortic pulse wave and arterial wall stiffness parameters of the large conduit arteries measured using applanation tonometry method with SphygmoCorPVx system by a single observer. In all patients polysomnography was performed using a all-night polysomnographic monitoring system EMBLA S4000, Remlogic with Somnologica studio 3.3.2 software. Apnea was defined as a cessation of airflow lasting for more than 10 sec. After primary evaluation eplerenone 50 mg once daily was added to existing antihypertensive treatment regimen in all subjects. After 3 months all procedures were repeated. Results: Eplerenone therapy reduced SBP24 h from 144,6+/−9,4 to 135,7+/−4,9 p < 0,05, DBP24 h from 87,8+/−7,9 to 84,1+/−4,9,p < 0,05, MAP24 h from 106,7+/−6,8 to 101,5+/−4,1 p < 0,05, PWV from 15,3+/−1,3 to 12,8+/−2,2 p < 0,05, AoAlx (%) from 31,6+/−4,2 to 27,1+/−4,6 p < 0,05, AlxHR75 (%) from 28,4+/−4,2 to 22+/−5,4 p < 0,05, AHI (/h) from 44,5+/−19,9 to 29,5+/−12,9 p < 0,05. There was a significant positive correlation between AHI and SBP24 h 0,487 p = 0,014, AHI and MAP 24 h 0,477p = 0,016 AHI and PWV 0,659 p = 0,003, AHI and AoAlx 0,436 p = 0,029, AHI and AlxHR75 0,530 p = 0,006. Conclusions: Treatment with eplerenone reduces severity of obstructive sleep apnoea in patients with resistant hypertension.