Despite carrying a minimal risk of adrenal vein rupture and at variance with the guidelines, AVS is not used systematically at major referral centers worldwide. These findings represent an argument for defining guidelines for this clinically important but technically demanding procedure.

Abstract-Observational studies indicate a significant relation between dietary sodium and level of blood pressure.However, the role of salt sensitivity in the development of resistant hypertension is unknown. The present study examined the effects of dietary salt restriction on office and 24-hour ambulatory blood pressure in subjects with resistant hypertension. Twelve subjects with resistant hypertension entered into a randomized crossover evaluation of low (50 mmol/24 hoursϫ7 days) and high sodium diets (250 mmol/24 hoursϫ7 days) separated by a 2-week washout period. Brain natriuretic peptide; plasma renin activity; 24-hour urinary aldosterone, sodium, and potassium; 24-hour ambulatory blood pressure monitoring; aortic pulse wave velocity; and augmentation index were compared between dietary treatment periods. At baseline, subjects were on an average of 3.4Ϯ0. Key Words: blood pressure Ⅲ hypertension Ⅲ resistant hypertension Ⅲ sodium Ⅲ diet O bservational studies and clinical trials performed in general populations indicate that a higher salt intake is associated with higher blood pressure (BP). For example, in the INTERSALT multi-national evaluation, which included both normotensive and hypertensive subjects, differences in dietary sodium ingestion of 100 mmol per day were associated with differences in systolic BP of approximately 2.2 mm Hg after adjustment for age, sex, potassium excretion, body mass index, and alcohol intake. 1 When limited to hypertensive subjects, the positive relation between salt ingestion and level of BP appears to be stronger. Meta-analyses of low-salt intervention trials indicate decreases in systolic BP of 3.7 to 7.0 mm Hg and diastolic BP of 0.9 to 2.5 mm Hg in hypertensive patients. [2][3][4][5] Resistant hypertension, defined as BP that remains above goal in spite of use of 3 antihypertensive medications is a common clinical problem. 6 Clinical trials suggest that 20% to 30% of hypertensive subjects may be resistant to multi-drug antihypertensive regimens. 7,8 Although the effects of reducing dietary sodium intake on office BP levels have been evaluated in general hypertensive patients, studies examining the role of dietary salt in patients with resistant hypertension have not been done. The aim of the present study was to determine the effects of dietary sodium restriction on office and 24-hour ambulatory BP in patients with resistant hypertension. Potential mechanisms of salt-related effects on BP (ie, volume retention and changes in vascular stiffness) were also explored. Methods SubjectsConsecutive subjects referred to the University of Alabama at Birmingham (UAB) Hypertension Clinic for resistant hypertension were recruited. The protocol was approved by UAB's Institutional Review Board for Human Use and all subjects provided written informed consent before study participation. Resistant hypertension was defined as uncontrolled hypertension (systolic BP Ͼ140 or diastolic BP Ͼ90 mm Hg) determined at Ն2 clinic visits despite the use of Ն3 antihypertensive medications at pharma...

IntroductionObstructive sleep apnea (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 following treatment with spironolactone.MethodsSubjects with resistant hypertension [clinic blood pressure (BP) ≥140/90 mm Hg on ≥3 antihypertensive medications, including a thiazide diuretic and OSA [defined as an apneahypopnea index (AHI) ≥ 15] had full diagnostic, polysomnography before and 8 weeks after spironolactone (25–50 mg/day) was added to their ongoing antihypertensive therapy.ResultsTwelve patients (mean age 56 years and body mass index 36.8 kg/m2) were evaluated. Following treatment with spironolactone, the AHI (39.8±19.5 vs. 22.0±6.8 events/hr; p < 0.05) and hypoxic index (13.6±10.8 vs. 6.7±6.6 events/hr; p < 0.05), weight, clinic and ambulatory BP were significantly reduced. Plasma renin activity and serum creatinine were significantly higher.ConclusionThis 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.