title: Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report.
abstract: Obstructive sleep apnoea (OSA) and hyperaldosteronism are very common in subjects with resistant hypertension. We hypothesized that aldosterone-mediated chronic fluid retention may influence OSA severity in patients with resistant hypertension. We tested this in an open-label evaluation by assessing the changes in the severity of OSA in patients with resistant hypertension after treatment with spironolactone. Subjects with resistant hypertension (clinical blood pressure (BP) >or=140/90 mm Hg on >or=3 antihypertensive medications, including a thiazide diuretic and OSA (defined as an apnoea-hypopnoea index (AHI) >or=15) had full diagnostic, polysomnography before and 8 weeks after spironolactone (25-50 mg a day) was added to their ongoing antihypertensive therapy. In all, 12 patients (mean age 56 years and body mass index 36.8 kg m(-2)) were evaluated. After treatment with spironolactone, the AHI (39.8+/-19.5 vs 22.0+/-6.8 events/h; P<0.05) and hypoxic index (13.6+/-10.8 vs 6.7+/-6.6 events/h; P<0.05), weight and clinic and ambulatory BP were significantly reduced. Plasma renin activity (PRA) and serum creatinine were significantly higher. This study provides preliminary evidence that treatment with a mineralocorticoid receptor antagonist substantially reduces the severity of OSA. If confirmed in a randomized assessment, it will support aldosterone-mediated chronic fluid retention as an important mediator of OSA severity in patients with resistant hypertension.
authors.affiliation: Division of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, LA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Gaddam
authors.forename: E
authors.initials: E
authors.lastname: Pimenta
authors.forename: S J
authors.initials: SJ
authors.lastname: Thomas
authors.forename: S S
authors.initials: SS
authors.lastname: Cofield
authors.forename: S
authors.initials: S
authors.lastname: Oparil
authors.forename: S M
authors.initials: SM
authors.lastname: Harding
authors.forename: D A
authors.initials: DA
authors.lastname: Calhoun
mesh_terms: D001794:Blood Pressure; D004232:Diuretics / Q000008:administration & dosage*; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000188:drug therapy*; D013148:Spironolactone / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D013148:Spironolactone