Objective: To evaluate the behavior of BP and endothelial function after spironolactone or clonidine, associated with optimized antihypertensive treatment in patients with resistant hypertension (PRH). Methods: Prospective and randomized study, visits every 4 weeks. VISIT (V) 0: Inclusion of patients with BP>160/100mmHg and <220mmHg. They receive chlorthalidone 25mg/day and Enalapril 40mg/day or Losartan 100mg/day. V1: If BP>140/90 amlodipine was added 5mg/day. Laboratory evaluation (LE), plasma renin and aldosterone and 20 min ECG, ABPM. V2: If BP>140/90 amlodipine titrated to 10mg/day. V3 (Randomization): ABPM, LE and assessment of endothelial function. If BP>140/90 and/or 24h ABPM>130/80 patients received spironolactone 12.5mg/day or clonidine 0.200mg/day. V4 and V5 (PRH): titration of clonidine (0.200mg to 0.600mg) or spironolactone (12.5mg to 50mg). V6: The same evaluation of V3. Patients with controlled BP in V3 have maintained their medication in V4, V5 and V6 and undergo the same tests that PRH. BP and ABPM was assessed by an automatic device; endothelial function by tonometry arteriolar peripheral (PAT) with Endo-PAT2000 ® and biomarkers (I-CAM, V-CAM, E-sel, PCR); plasma renin and aldosterone by RIA. Results: So far the study evaluated 46 patients where 28 patients had controlled BP and 13 remained resistant. In the spironolactone group the 24h-BP behavior, assessed by ABPM was SBP (V1) 162,8±7,9 and (V6) 124,3±3,7 (p<0,05), DBP (V1) 99,7±5,1 and (V6) 78,2±6,3 (p<0,05); while in the clonidine group SBP (V1) 158,8±11,7 and (V6) 134±19 (p<0,05), DBP (V1) 92±8,4 and (V6) 87,5±13,5 (p<0,05). In the controlled BP group SBP (V1) 134,4±2,7 and (V6) 124,3±3,1 (p<0,05), DBP (V1) 85,2±1,7 and (V6) 78,5±2,5 (p<0,05). The reactive hyperemia index (RHI) determined by the PAT in the spirolactone group was V3: 1,83 ± 0,13 and V6: 1,84 ± 0,2; clonidine group V3: 1,72 ± 0,22 and V6: 1,9 ± 0,6 and controlled BP group V3: 1,87 ± 0,08 and V6: 2,0 ± 0,12. Conclusion: Despite the statistically significant reduction of BP with spironolactone and clonidine, it seems that the improvement in endothelial function has been most pronounced in the clonidine group, although without statistical relevance.
Background: Obstructive sleep apnea (OSA) is considered an independent risk factor for cardiovascular disease and reported as the most common secondary cause of high blood pressure (BP) maintenance. Objective: To determine the prevalence of OSA and verify its association with endothelial function behavior and anthropometric parameters in patients with resistant hypertension (RHGroup) and BP controlled by medication (CHGroup). Methods: Cross-sectional study involving 40 hypertensive patients (20 in RHG and 20 in CHG), aged between 18 and 75 years. Endothelial function and OSA were assessed by peripheral arterial tonometry. BP was measured by oscillometric method on automatic device. Endothelial function was assessed by peripheral arterial tonometry (PAT) by EndoPAT2000 and the OSA diagnosis also through PAT, using the portable device WatchPAT200. Anthropometric evaluation was performed through measurements of waist (WaC), hip and neck circumference (NC), BMI, waist to height ratio (WHtR), and body composition assessed by BIA. Results: The prevalence of OSA in RHG was 85% (17 of 20)[apnea-hypopnea index = 12.39±1.89], and 80% (16 of 20) in CHG (AHI=20.74±4.69) and it was more frequent in men (93.7% [15 of 16] vs 75% [16 of 24]; p=0.0455, OR =3.86; 95% IC 0.99 to 5.09). Both groups presented similar anthropometric parameters values. Endothelial function evaluated by reactive hyperemia index was similar in both groups (RHG: 1.88±0.44 vs CHG: 2.03±0.43; p=0.47). Although we found differences in oxygen desaturation> 4% (RHG: 28.75 ± 5.08 vs CHG: 64.15 ± 16.97, p = 0.05), total sleep time (RHG: 307.2 ± 71.3 vs CHG: 323.3 ± 83.8 min) and minimum saturation (RHG: 87.8±3.8 vs CHG: 83.3±10.6%) was not different. In general, OSA was correlated with weight (r = 0.5135, p = 0.0007), BMI (r = 0.4146, p = 0.0078), WaC (r = 0, 4458, p = 0.005), NC (r = 0.3863, p = 0.01) and WHtR (r = 0.3907, p = 0.01) and independently associated with impairment of endothelial function (p = 0.0297, OR = 0.17, 95% CI 0.04 to 0.72). Conclusions: The findings of the present study show that the prevalence of OSA was similar in both groups and suggest that, in hypertensive subjects, OSA occurs more frequently in men, being associated with endothelial dysfunction and correlated positively with weight, BMI and WaC.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.