Risk Factors And Heart/Kidney Damage In Resistant Hypertension Subjects With Obstructive Sleep Apnea Hypopnea Syndrome

ObjectiveIn this study, overnight polysomnography were used to diagnose OSAHS in100resistant hypertension patients(exclusion of other common secondaryhypertensions),.According to the results of PSG, people were divided into two groups: RHand RH+OSAHS. Compared with BMI, history of smoking, classes of takingantihypertension medications, duration of hypertension, serum lipid level, fasting bloodglucose, serum uric acid, estimated glomerular filtration rate(eGFR), recunbent plasmarennin-angiotensionⅡ-aldosterone level, ambulatory blood pressure monitoringparameters and LVMI between two groups. Analysis of risk factors and target organsdamage in RH subjects with OSAHS.SubjectA total100resistant hypertension subjects were enrolled in this study from2010. Janto2011. Jun. by hypertension department of Beijing Anzhen Hospital. According to theresults of PSG, people were divided into two groups: RH and RH+OSAHS.RH group of46cases, mean age(53.63±12.24)years, RH+OSAHS group of54cases, meanage(48.13±12.29)years.MethodsAll subjects carried out overnight polysomnography, sleep apnea-hypopnea index≥5times/hour diagnosed OSAHS.According to the results of PSG, people were divided intotwo groups: RH and RH+OSAHS.A standardized history and physical examination wasperformed prior to biochemical analysis. Ambulatory blood pressure monitoring wasmeasured, plasma renin level and plasma aldosterone concentration measured by radioimmunoassay. Blood samples were collected in fasted subjects between5am and6amin supine position during their normal diet. Interventricular septal thickness, LeftVentricular end-diastolic diameter, porerior wall thickness were measured byechocardiography.Results①Compare to RH, RH+OSAHS has significant differences in age(48.13±12.29years vs53.63±12.24years, P＜0.05)、duration of hypertension (9（3,16）years vs10（6,20）years,P＜0.05)、UA(（437±81）μmol/L vs（385±72）μmol/L, P＜0.05)、LDL(（3.0±0.6）mmol/L vs（2.7±0.5）mmol/L，P＜0.05)、AHI（25(12,67) vs2(1,4), P＜0.05）、miniSpO2（90.9±3.7vs79.1±10.3, P＜0.05）、meanSpO2（97.1±1.3vs93.5±2.4, P＜0.05）.②Compare to RH, RH+OSAHS has significant differences in blood pressure.RH+OSAHSgroup had higher24DBP（80.52±9.53vs85.50±9.96,P＜0.05）、24MAP(96.91±8.04vs101.48±8.87,P＜0.05)、DMAP(98.48±8.66vs103.28±9.21，P＜0.05)、NMAP(92.93±10.22vs97.91±10.87,P＜0.05)。③Compare to RH, RH+OSAHS has significant differences in PRA（0.78(0.19,1.96) vs1.44(0.56,3.09),P＜0.05）。④Compare to RH, RH+OSAHS has no significant differences in eGFR（97.96±20.66vs92.01±29.52,P＞0.05）； but had significant differences in IVST （10.36±1.44vs11.58±1.66,P＜0.05）、 LVEDd （46.57±4.87vs50.28±4.90,P＜0.05） and LVMI（112.43±17.05vs128.10±21.47, P＜0.05）。⑤risk factors of OSAHS in RH:The univariate regression showed that: age[β=-0.037,OR0.964(0.932-0.997)]、duration of hypertension[β=-0.058,OR0.964(0.932-0.997)]、24DBP[β=-0.053,OR1.054(1.010-1.101)]、24MAP[β=0.063,OR=1.065(1.013-1.121)]、UA[β=0.009,OR1.0091.003-1.014)]、LDL[β=0.785,OR=2.193(1.003-1.014)], thenmultivariate logistic regression showed that24MAP[β=-0.06,OR1.065(1.008-1.124)]UA[β=-0.009,OR1.009(1.003-1.015)],LDL[β=1,OR1.877(0.854-4.128)]wereindependent risk factors of OSAHS in resistance hypertensions.⑥risk factors of left ventricular hypertrophy in RH+OSAHS: multivariate logistic 3.2,95%CI1.19-4.62), PRA(β=0.25,OR1.28,95%CI1.01-1.63)were independent riskfactors of left ventricular hypertrophy in RH+OSAHS.Conclusion①Resistance hypertension subjects with obstructive sleep apnea/hypopnea syndrome arecommon in middle-aged male patients. The main clinical characters were difficultcontrolled blood pressure,more combined with metabolic abnormalities, and more prone toleft ventricular hypertrophy.②This study suggests that metabolic abnormalities is an important predictor of OSAHS inresistance hypertension, which could guide early detection and diagnosis of OSAHS inclinic.③AHI、LDL and PRA were independent risk factors of left ventricular hypertrophy inRH+OSAHS,suggesting we should control and reduce the degree of OSAHS, andACEI/ARB maybe used as soon as possible to reverse ventricular remodeling.