J Clin Hypertens (Greenwich). Liddle syndrome (LS) is an autosomal dominant disorder due to a gain‐of‐function mutation in the epithelial Na+ channel and is perceived to be a rare condition. A cross‐sectional study of 149 hypertensive patients with hypokalemia (<4 mmol/dL) or elevated serum bicarbonate (>25 mmol/dL) was conducted at a Veterans’ Administration Medical Center Hypertension Clinic in Shreveport, LA. Data on demographics, blood pressure, and select blood tests were collected and expressed as percentages for categoric variables and as mean ± standard deviation (SD) for continuous variables. Patients were diagnosed with likely LS when the plasma renin activity (PRA) was <0.35 μU/mL/h and the aldosterone was <15 ng/dL and likely primary hyperaldosteronism (PHA) with PRA <0.35 μU/mL/h and aldosterone level >15 ng/dL. The cohort included predominantly elderly (67.1±13.4 years), male (96%), and Caucasian (57%) patients. The average blood pressure was 143.8/79.8 mm Hg±27.11/15.20 with 3.03±1.63 antihypertensive drugs. Based on the above criteria, 9 patients (6%) satisfied the criteria for likely LS and 10 patients (6.7%) were diagnosed with likely PHA. In this hypothesis‐generating study, the authors detected an unusually high prevalence of biochemical abnormalities compatible with likely LS syndrome from Northwestern Louisiana, approaching that of likely PHA. J Clin Hypertens (Greenwich). 2010;12:856–860.

Nocturnal hypoxemia as determined by a polyvariable biomarker reliably predicted EDS in patients with severe OSA (AHI>50), indicating that oxygen fluctuation had a direct role in the development of EDS in patients with severe OSA.

In an observational study in 19 consecutive acutely hospitalized dialysis patients, ultrafiltration (UF) volume was determined by B‐type natriuretic peptide (BNP) levels. Patients were ultrafiltrated daily until they achieved a target BNP level <500 pg/mL. The UF volumes ranged from 2 to 5 L per session. All patients were male veterans aged 68±11 years (mean ± SD), 74% were diabetic, 47% were African Americans, 58% underwent prevalent dialysis, and 53% had an arteriovenous fistula. Left ventricular ejection fraction on 2‐dimensional echocardiography was 43.8%±27.9% (n=16). The admission BNP was 2412±1479 pg/mL (range, 561–5000 pg/mL) and BNP at hospital discharge was 1245±1173 pg/mL (range, 345–5000 pg/mL) (nonparametric Wilcoxon P=.0013). Admission weight was 88.9±27.9 kg and at discharge was 78.1±25.6 kg (P=.0002). The number of antihypertensive medications taken was 3.8±2.0 at admission and 2.3±1.7 at discharge (P=.0005). The number of patients with >2 blood pressure medications decreased from 14 to 6 (Fisher exact test, P=.02). The systolic/diastolic/mean arterial blood pressure decreased from admission to discharge (153.6±43.8/80.6±21.8/102.4±27.3 to 132.1±27.9/68.9±14.6/89.9±16.5 mm Hg; P=.0222/.0139/.0329, respectively). Although all patients were volume‐overloaded at admission according to BNP criteria (>500), only 42% were identified as having heart failure. BNP‐directed UF is safe because it minimizes symptomatic hypotension, identifies occult congestive heart failure in a large number of patients, and significantly reduces blood pressure in addition to reducing body weight and number of medications used.

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