Abstract
Objective To investigate the influence of continuous positive airway pressure( CPAP)on the plasma aldosterone concentration(PAC)in patients with resistant hypertension and obstructive sleep apnea(OSA). Methods From July 2012 to October 2013,we enrolled 513 patients with resistant hypertension and OSA who were admitted into Henan Province Hospital of TCM and accorded with inclusion criteria. 17 patients who didn’t received 24 h ABPM and 16 patients with AHI less than 15 times per hour were excluded,and other 480 patients were divided into CPAP group(n = 240)and control group(n= 240)by random number table method. CPAP group and control group respectively received CPAP plus medication and medication alone for 3 months. We recorded patients’ general data,24 h ABPM indexes( daytime SBP,daytime DBP,night SBP,night DBP,24 h SBP and 24 h DBP), Epworth sleepiness score, PAC level and renin level before and after treatment. Results A total of 468 patients finished treatment,including 232 patients in the CPAP group and 236 patients in the control group. According to 24 h ABPM before treatment,hypertension ﹤ 125 / 80 mm Hg(1 mm Hg = 0. 133 kPa)was defined as pseudo resistant hypertension,and hypertension ≥125 / 80 mm Hg was defined as true resistant hypertension. There were 113 pseudo resistant hypertension patients and 119 true resistant hypertension in CPAP group;there were 133 pseudo resistant hypertension patients and 103 true resistant hypertension in control group. True resistant hypertension patients were not significantly different from pseudo resistant hypertension patients in CPAP time(P ﹥ 0. 05). CPAP group was lower than control group in the usage rate of diuretic(P ﹤ 0. 05). For pseudo resistant hypertension patients,patients who received medication alone and patients who received CPAP plus medication were significantly different in daytime DBP,night SBP,night DBP and 24 h SBP before treatment and daytime DBP,AHI,Epworth sleepness score and PAC level after treatment( P ﹤ 0. 05);the daytime DBP and AHI of patients who received medication alone after treatment were significantly different from those before treatment(P ﹤ 0. 05);the night DBP,AHI,Epworth sleepiness score and PAC level of patients who received CPAP plus medication after treatment were significantly different from those before treatment( P ﹤ 0. 05). For patients with true resistant hypertension,patients who received medication alone and patients who received CPAP plus medication were significantly different in night SBP,24 h SBP and AHI before treatment and daytime SBP,daytime DBP,night SBP,night DBP,24 h DBP,AHI and PAC level after treatment(P ﹤ 0. 05);the AHI of patients who received medication alone after treatment was significantly different from that before treatment(P ﹤ 0. 05);the daytime SBP,daytime DBP,night SBP,night DBP,24 h DBP,AHI, Epworth sleepiness score and PAC level of patients who received CPAP plus medication after treatment were significantly different from those before treatment( P ﹤ 0. 05) . With PAC before treatment as the dependent variable and age,BMI,CT90% , 24 h SBP before treatment,24 h DBP before treatment,and AHI before treatment as independent variables,multiple linear regression analysis was conducted,and the result showed that the regression equation was y = 0. 198 × CT90% + 0. 058( P= 0. 023,R2 = 0. 026). With PAC after treatment as the dependent variable,and age,BMI,CT90% ,24 h SBP before treatment,24 h DBP before treatment,and AHI before treatment as independent variables,multiple linear regression was conducted,and the result showed that the regression equation was y = 0. 168 × 24 h DBP + 0. 113(P = 0. 015,R2 = 0. 094). Conclusion PAC may participate in the development of OSA and resistant hypertension,and CPAP can effectively improve the PAC level of patients with resistant hypertension combined with OSA.关键词
高血压/睡眠呼吸暂停,阻塞性/连续气道正压通气/醛固酮Key words
Hypertension/Sleep apnea,obstructive/Continuous positive airway pressure/Aldosterone分类
医药卫生
