The Effects of Eplerenone on the Circadian Blood Pressure Pattern and Left Ventricular Hypertrophy in Patients with Obstructive Sleep Apnea and Resistant Hypertension-A Randomized, Controlled Trial.

Beata Krasińska,Lech Paluszkiewicz,Andrzej Tykarski,Piotr Rzymski,Tomasz Trafas,Zbigniew Krasiński,Ludwina Szczepaniak-Chicheł,Szczepan Cofta

doi:10.3390/jcm8101671

Abstract

The obstructive sleep apnea (OSA) is highly associated with various significant cardiovascular outcomes such as resistant hypertension (RAH). Despite this, as of now the relationship between high night-time blood pressure (BP) and left ventricular hypertrophy (LVH) in patients with OSA and RAH is not fully understood. The aim of this study was to assess the influence of the addition of eplerenone to a standard antihypertensive therapy on parameters of 24-h ambulatory blood pressure measurement (ABPM) as well as on the results of echocardiography and polysomnography in patients with OSA and RAH. The patients were randomly assigned to one of the two study groups: the treatment group, receiving 50 mg/d eplerenone orally for 6 months (n = 51) and the control group, remaining on their standard antihypertensive therapy (n = 51). After that period, a significant reduction in the night-time BP parameters in the treatment group including an increased night blood pressure fall from 4.6 to 8.9% was noted. Additionally, the number of non-dipper patients was reduced by 45.1%. The treatment group also revealed a decrease in left ventricular hypertrophy and in the apnea–hypopnea index (AHI) with a positive correlation being observed between these two parameters. This study is the first to report the improvement of the circadian BP profile and the improvement of the left ventricle geometry in patients with OSA and RAH following the addition of selective mineralocorticoid receptor antagonists to antihypertensive therapy.

Highlights

The prevalence of obstructive sleep apnea (OSA) appears to increase, and currently affects over 20% of men and over 15% of women [1,2]
The study involved 51 patients (29 males and 22 females) with median age of 59 years assigned to Group 1—add-on 6-month therapy with eplerenone (50 mg/daily) and to Group 2 (30 males and 21 females) receiving standard antihypertensive therapy
This study is the first to report the improvement of the circadian blood pressure (BP) profile and enhancement of the left ventricle geometry in the group of patients with resistant hypertension (RAH) and OSA after the addition of selective mineralocorticoid receptor antagonists (MRAs)—eplerenone

Summary

Introduction

The prevalence of obstructive sleep apnea (OSA) appears to increase, and currently affects over 20% of men and over 15% of women [1,2]. It is known that OSA is highly associated with various significant cardiovascular outcomes such as resistant hypertension (RAH) [3,4,5]. This specific group of patients is burdened with a very high risk of cardiovascular complications and reveals an extensive organ damage, primarily in the form of left ventricular hypertrophy (LVH) [6]. In patients with OSA, frequent episodes of hypoxemia, hypercapnia, and arousals during sleep result in the repeated activation of the sympathetic nervous system with increased secretion of catecholamines. The episodes of respiratory distress increase aldosterone serum concentration, resulting in sodium and water retention, leading to elevated blood pressure (BP). An increased aldosterone level stimulates synthesis of collagen, promotes stiffening of the arterial wall, myocardial fibrosis with heart muscle remodeling, and contributes to the development of LVH

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