Effects of continuous positive airway pressure treatment on aldosterone excretion in patients with obstructive sleep apnoea and resistant hypertension

Jan 28, 2017Journal of hypertension

Continuous positive airway pressure treatment and its effects on aldosterone levels in patients with obstructive sleep apnea and hard-to-treat high blood pressure

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Abstract

A borderline significant reduction in 24-hour urinary aldosterone excretion of -2.5 μg/24 h was observed after CPAP treatment in patients with resistant hypertension and obstructive sleep apnoea.

Patients with severe obstructive sleep apnoea had higher baseline aldosterone levels compared to those with moderate obstructive sleep apnoea.
In a per-protocol analysis, the CPAP group experienced a greater reduction in aldosterone excretion (-3.3 μg/24 h) compared to the control group.
The reduction in aldosterone excretion was significant in patients with uncontrolled ambulatory blood pressures.
The effect of CPAP treatment was more pronounced in patients who did not use spironolactone, were less obese, and had lower sleep oxygen saturation levels.

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OBJECTIVE: Aldosterone excess has been equally associated with resistant hypertension (RHT) and obstructive sleep apnoea (OSA). We conducted a randomized controlled study to assess the effect of continuous positive airway pressure (CPAP) treatment on 24-h urinary aldosterone excretion in patients with RHT and moderate/severe OSA.

METHODS: A total of 117 patients were randomized (57 CPAP and 60 control groups). Aldosterone excretion was determined by 24 h urine (24h-UAldo) collected at randomization and after 6 months of follow-up. Twenty-four hour UAldo differences were assessed by general linear model with the allocation group (CPAP or control) as a fixed factor adjusted for their respective baseline values. Both intention-to-treat and per-protocol (45 patients with optimal adherence to CPAP) analyses were performed.

RESULTS: Baseline 24h-UAldo was higher in severe OSA than in moderate OSA patients. After CPAP treatment, there was a borderline significant reduction in 24h-UAldo [mean difference: -2.5 μg/24 h; 95% confidence interval (95% CI): -5.3 to +0.3 μg/24 h; P = 0.07] in intention-to-treat analysis, whereas in the per-protocol analysis, the CPAP group had a greater reduction in 24h-UAldo than the control group (mean difference: -3.3 μg/24 h; 95% CI: -6.1 to -0.4 μg/24 h; P = 0.027). This effect occurred solely in patients with uncontrolled ambulatory BPs, and was more pronounced in those with the nondipping pattern, not using spironolactone, less obese, and with lowest sleep SaO2 levels.

CONCLUSION: Only optimal CPAP treatment reduced aldosterone excretion in patients with uncontrolled RHT, while on intention-to-treat the effect was borderline. Although nondefinitive, our results suggest that CPAP treatment might improve cardiovascular outcomes by reducing aldosterone excess in resistant hypertensive individuals with OSA.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01508754.

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Effects of continuous positive airway pressure treatment on aldosterone excretion in patients with obstructive sleep apnoea and resistant hypertension

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