Sleep apnea, aldosterone, and resistant hypertension.
Obstructive sleep apnea, aldosterone excess, and resistant hypertension are common comorbidities in obese patients. The mechanisms that link these conditions are not fully elucidated, but sympathetic nervous system activation, sodium retention, renin-angiotensin-aldosterone system stimulation, endothelial dysfunction, and increased production of reactive oxidative species may be contributing factors. Patients diagnosed with this triad should be treated with low-salt diet, weight-loss counseling, and continuous positive airway pressure, as well as aggressive antihypertensive therapy, usually with multiple agents, including a mineralocorticoid receptor antagonist. Patients with aldosterone-producing adenoma may require adrenalectomy.
Pimenta
Eduardo
E
Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, Sao Paulo, SP, Brazil. espimenta@hotmail.com
Calhoun
David A
DA
Oparil
Suzanne
S
D000315:Adrenalectomy; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure; D003376:Counseling; D004038:Diet, Reducing; D004039:Diet, Sodium-Restricted; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D009765:Obesity / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D018384:Oxidative Stress; D012084:Renin-Angiotensin System; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D013564:Sympathetic Nervous System / Q000503:physiopathology; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists