Changes in Plasma Angiotensin II and Circadian Rhythm of Blood Pressure in Hypertensive Patients with Sleep Apnea Syndrome Before and After Treatment

Abstract

Ang II might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang II level in patients with obstructive SAS.

Influence and implications of the renin–angiotensin–aldosterone system in obstructive sleep apnea: An updated systematic review and meta‐analysis

“…A total of 17 studies examined PAC (Barceló et al, 2014 ; Cho et al, 2015 ; di Murro et al, 2010 ; Follenius et al, 1991 ; Gjorup et al, 2007 ; Ishikawa et al, 2008 ; Ke et al, 2017 ; Li et al, 2019 ; Lykouras et al, 2015 ; Maillard et al, 1997 ; Moller et al, 2003 ; Muxfeldt et al, 2014 ; Nishijima et al, 2014 ; Svatikova et al, 2009 ; Thunstrom et al, 2016 ; Zalucky et al, 2015 ; Zhang et al, 2019 ), whereas seven articles reported AngII levels (Gjorup et al, 2007 ; Ishikawa et al, 2008 ; Moller et al, 2003 ; Takahashi et al, 2005 ; Wang et al, 2011 ; Zalucky et al, 2015 ; Zhang et al, 2019 ) compared with people without OSA. Seventeen studies compared blood pressure between people with OSA and those without (Barceló et al, 2014 ; Cho et al, 2015 ; di Murro et al, 2010 ; Florczak et al, 2013 ; Gjorup et al, 2007 ; Ishikawa et al, 2008 ; Ke et al, 2017 ; Li et al, 2019 ; Lykouras et al, 2015 ; Moller et al, 2003 ; Muxfeldt et al, 2014 ; Nishijima et al, 2014 ; Svatikova et al, 2009 ; Thunstrom et al, 2016 ; Wang et al, 2011 ; Zalucky et al, 2015 ; Zhang et al, 2019 ). Twelve studies were conducted in Western population and eight were conducted in Asian population, mainly the Japanese and Chinese.…”

“…Abbreviations: AHI, apnea-hypopnea index; AngII, angiotensin II; ANP, atrial natriuretic peptide; ARR, aldosterone renin ratio; BP, blood pressure; eGFR, estimated glomerular filtration rate; EH, essential hypertension; HDL-C, high-density lipoprotein cholesterol; HPT, hypertension; MS, metabolic syndrome; NA, not available; NOS, Newcastle-Ottawa Scoring; OSA, obstructive sleep apnea; PA, primary aldosteronism; PAC, plasma aldosterone concentration; PAI-1, plasminogen activator inhibitor-1; RDI, Respiratory Disturbance Index; RHPT, resistant hypertension; SAS, sleep apnea syndrome; T2DM, Type 2 diabetes mellitus; TG, triglyceride; VEGF, vascular endothelial growth factor; WC, waist circumference.T A B L E 2 Study primary findings and additional reports Abbreviations: AHI, apnea-hypopnea index; AngII, angiotensin II; ANP, atrial natriuretic peptide; ARR, aldosterone renin ratio; BP, blood pressure; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; EH, essential hypertension; HDL-C, high-density lipoprotein cholesterol; HPT, hypertension; hsCRP, high-sensitivity C-reactive protein; MS, metabolic syndrome; NA, not applicable; NOS, Newcastle-Ottawa Scoring; OSA, obstructive sleep apnea; PA, primary aldosteronism; PAC, plasma aldosterone concentration; PAI-1, plasminogen activator inhibitor-1; PRA, plasma renin activity; RHPT, resistant hypertension; SAS, sleep apnea syndrome; SBP, systolic blood pressure; T2DM, type 2 diabetes mellitus; TG, triglyceride; VEGF, vascular endothelial growth factor; WC, waist circumference Muxfeldt et al, 2014;Nishijima et al, 2014;Svatikova et al, 2009;Thunstrom et al, 2016;Wang et al, 2011;Zalucky et al, 2015;Zhang et al, 2019)…”

Primary aldosteronism and obstructive sleep apnea: What do we know thus far?

“…The use of CPAP therapy, ranging from 1 week to 12 months, among different cohort of patients with OSA, ie presence of metabolic syndrome ( 11 ), normotension ( 41 ), essential ( 42 – 45 ) and resistant hypertension ( 46 , 47 ), and type 2 diabetes ( 40 ), showed significant reduction in RAAS components. Several studies which demonstrated lack of reduction in the RAAS components were mostly limited by a small sample size or short duration of CPAP use ( 48 – 53 ).…”

Metabolic dysfunction in obstructive sleep apnea: A critical examination of underlying mechanisms

“…In particular, elevated FFA induce endothelial dysfunction via vascular ROS 38 and induce skeletal muscle insulin resistance and inflammation. 39 Second, OSA 40,41 as well as experimental IH exposure in humans 42 and rodents 43 activates the renin-angiotensin system. Angiotensin II has potent effects on blood pressure, inflammation and oxidative stress, 44 in part through its action on endothelial NADPH oxidase.…”